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Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot
P Munkhammar1, S Cullen, P Jögi
1Department of Pediatric Cardiology, University Hospital of Lund, Sweden.
Insights
Restrictive right ventricular (RV) physiology after tetralogy of Fallot repair is linked to older age at repair. Long-term monitoring is essential to evaluate pulmonary regurgitation effects.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Cardiac Physiology
Background:
- Restrictive right ventricular (RV) physiology post-tetralogy of Fallot repair is associated with repair type, pulmonary regurgitation, and arrhythmias.
- Understanding RV diastolic function is crucial for long-term outcomes.
Purpose of the Study:
- To evaluate diastolic right ventricular (RV) function following surgical repair of tetralogy of Fallot in infants.
- To identify factors influencing restrictive RV physiology.
Main Methods:
- Doppler echocardiography was used to assess RV diastolic function in 47 patients post-tetralogy of Fallot repair.
- Patients were stratified by repair type (transatrial vs. transventricular) and age at repair.
Main Results:
- 28% of patients exhibited restrictive RV physiology.
- Restrictive physiology was more prevalent in patients repaired after 9 months of age (38%) compared to those repaired before 6 months (10%).
- Patients with restrictive RV physiology had more severe preoperative pulmonary stenosis and were older at repair.
Conclusions:
- Age at repair is inversely related to restrictive RV physiology, independent of outflow tract repair type.
- Transannular patch repair, common in early repairs, was associated with less restriction.
- Mandatory long-term follow-up is needed to assess pulmonary regurgitation's adverse effects.
Objectives:
To assess diastolic right ventricular (RV) physiology after tetralogy of Fallot repair in infancy.
Background:
Restrictive RV physiology after tetralogy of Fallot repair is related to type of repair, pulmonary regurgitation, and late arrhythmias.
Methods:
Forty-seven patients were investigated, 27 and 20 patients in Lund and London, respectively. Median age at repair was 0.78 years (0.08-0.99) and median follow-up was 3.0 years (0.08-10.4). Restrictive RV physiology was assessed by Doppler echocardiography.
Results:
Thirteen patients (28%) had restrictive RV physiology at follow-up, three of 19 patients (16%) with transatrial repair and 10 of 28 patients (32%) with transventricular repair, respectively (p=0.1). Ten percent of the patients repaired before 6 months of age were restrictive at follow-up, increasing to 38% with repair after 9 months. Transannular patch (TAP) repair was performed in 55% of the patients, including eight of 10 patients (80%) with repair before 6 months of age. Thirty-one percent of the patients with TAP repair were restrictive. These restrictive patients had more severe preoperative pulmonary stenosis (p < 0.05), were older at repair (p < 0.05), and had shorter duration of pulmonary regurgitation (p < 0.001) at follow-up.
Conclusions:
Restrictive RV physiology is inversely related to age at repair and independent of type of outflow tract repair. Since TAP repair is more common in early repair, and restriction seems to be less frequent, long-term follow-up to assess adverse effects of pulmonary regurgitation is mandatory.