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Usefulness of left ventricular volume in assessing tetralogy of Fallot for total correction
Insights
Patients with tetralogy of Fallot and adequate left ventricular (LV) end-diastolic volume index (EDVI) of 30 ml/m2 or more can undergo primary repair. Those with lower EDVI require initial palliative shunt procedures before later total correction.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Cardiovascular Physiology
Background:
- Tetralogy of Fallot is a complex congenital heart defect requiring surgical intervention.
- Assessing preoperative left ventricular (LV) size is crucial for successful intracardiac repair.
- Previous outcomes highlighted the risk of LV failure in patients with diminished LV end-diastolic volume index (EDVI).
Purpose of the Study:
- To evaluate the minimum LV end-diastolic volume index (EDVI) required for successful primary intracardiac repair of Tetralogy of Fallot.
- To establish criteria for selecting patients for primary repair versus palliative procedures.
Main Methods:
- Retrospective analysis of 91 patients undergoing intracardiac repair for Tetralogy of Fallot (1978-1981).
- Hemodynamic studies to determine the minimal EDVI for adequate postoperative cardiac output.
- Case review of 3 patients with low EDVI who underwent primary repair with supportive measures.
Main Results:
- A single mortality due to left-sided heart failure was linked to a significantly decreased LV EDVI (21 ml/m2).
- Postoperative studies suggested an EDVI of 30 ml/m2 as the minimum for adequate cardiac output.
- Three patients with EDVI around 30 ml/m2 successfully underwent primary repair with temporary atrial pacing and catecholamine support.
Conclusions:
- Patients with Tetralogy of Fallot and an EDVI ≥ 30 ml/m2 are suitable candidates for primary intracardiac repair.
- Patients with an EDVI < 30 ml/m2 should initially undergo palliative systemic-to-pulmonary arterial shunt.
- Subsequent total correction in patients with initially low EDVI should be delayed until sufficient LV growth is achieved.
Abstract:
Ninety-one patients with tetralogy of Fallot underwent intracardiac repair between 1978 and 1981. One patient died from left-sided heart failure. Retrospective analyses of this death revealed a significant decrease of the left ventricular (LV) end-diastolic volume index (EDVI) of 21 ml/m2 (36% of normal). Results of early postoperative hemodynamic studies after total correction of this anomaly suggested that an EDVI of 30 ml/m2 is the minimal requirement for adequate cardiac output postoperatively. Based on these data, 3 patients with decreased LV volume with EDVI of around 30 ml/m2 were challenged with the primary repair with success, although they required atrial pacing and catecholamine support postoperatively to maintain adequate left atrial pressure and cardiac output. From these results, it is recommended that patients with tetralogy of Fallot and an EDVI of 30 ml/m2 or more can be considered as candidates for the primary repair, but that patients with an EDVI of less than 30 ml/m2 should be palliated once by systemic-to-pulmonary arterial shunt procedures. Subsequent total correction should be performed after sufficient LV growth for those patients.