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[Tetralogy of Fallot: long-term evolution following corrective surgery]
Insights
Complete surgical correction of tetralogy of Fallot (TF) in children offers excellent long-term survival. Life-threatening complications are rare after the first postoperative year for successfully treated TF patients.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Tetralogy of Fallot Repair
Context:
- Tetralogy of Fallot (TF) is a complex cyanotic congenital heart disease.
- Surgical correction aims to improve survival and quality of life.
- This study reviews outcomes of TF repair over a 12-year period.
Purpose:
- To evaluate the immediate and long-term results of complete surgical correction for tetralogy of Fallot (TF).
- To assess survival rates and identify risk factors for mortality and complications post-TF repair.
Summary:
- A review of 275 children undergoing TF repair between 1972-1984 showed a 90% survival rate at one year, decreasing slightly to 88% by 11 years.
- Overall mortality was 9.8%, with a significant decrease in recent years (5.7% post-1978).
- Complications included residual pulmonary stenosis and shunts, but severe issues were infrequent after the first postoperative year.
Impact:
- Surgically treated tetralogy of Fallot patients demonstrate excellent long-term survival.
- Mortality rates have significantly improved with surgical advancements.
- Postoperative complications are manageable, with rare life-threatening events beyond the initial year.
Abstract:
To evaluate the immediate and long term results of complete correction of tetralogy of Fallot (TF), we have reviewed the records of 275 children operated on in Geneva between 1972 and end 1984. The average age at operation was 6 7/12 years (range 7 months to 16 years). Postoperative follow-up ranged from 1 year to 12 years (average 3 7/12 years). The survival rate, taking into account immediate postoperative mortality, was 90 +/- 2% after one year, 88 +/- 2% after 5 years and 88 +/- 2% after 11 years for the entire patient group. The total mortality of 9.8% has markedly decreased in recent years (14.5% before and 5.7% after 1978). Mortality is highest within the first 30 days after the operation (20 cases, 7.3%). Mortality was higher after previous palliative surgery (5/51) and for children who had to be reoperated for a residual lesion (4/23). Once the first postoperative year has passed, mortality is low: 2 deaths occurred between 1 and 2 years, and one between 2 and 5 years after the operation. Cardiac catheterization in 218 patients between 2 months and one year after surgery showed severe residual pulmonary stenosis in 4 children which made reoperation necessary; a second operation was needed for a large left-to-right shunt in 5 cases, and because of a ventricular septal defect with residual pulmonary stenosis in 6 others. Pulmonary insufficiency was noted in 106 cases (38.5%) but only 3 children showed right heart insufficiency. One child underwent pulmonary valve replacement by Björk-Shiley prosthesis. It can be concluded that a child with surgically treated TF has excellent long term survival, and that life threatening complications after the first postoperative year are rare.