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Ann Thorac Surg 2007;83:1790-1795
© 2007 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Long-Term Functional Assessment After Correction of Tetralogy of Fallot in Adulthood

^a Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
^b Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India

Accepted for publication January 9, 2007.

^_* Address correspondence to Dr Shyamkrishnan, Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695011, Kerala, India (Email: kgs{at}sctimst.ac.in).

Background: Tetralogy of Fallot presenting in adulthood is a surgical challenge. We present the long-term outcomes of surgical correction in this subset of patients, including results of postoperative effort tolerance as assessed by treadmill testing.

Methods: Fifty-eight patients older than 18 years operated on between January 1995 and June 2004 are included in the study. Mean age at surgery was 22.5 ± 5 years. Forty-seven patients were in New York Heart Association functional class II and 11 were in class III. Two patients had previous shunts. Forty-four patients received a transannular patch, and 14 had a right ventricular outflow tract patch. The prospective arm objectively assessed postoperative ventricular function by treadmill testing and echocardiography.

Results: Hospital mortality was 6.9%. Follow-up was 89% complete, with mean follow-up of 69.9 ± 43 months. Late mortality occurred in 2 patients, both with infective endocarditis. Significant improvement in functional class was demonstrated (p < 0.001). Eight patients had significant pulmonary regurgitation on follow-up. The probability of survival after repair was 89% at 15 years. Thirty-five of 36 patients who underwent treadmill testing had good effort tolerance, with an average of 10.47 ± 1.4 metabolic equivalents achieved. None had a positive result. One patient with transannular patch, in functional class III, had fair exercise tolerance with severe pulmonary regurgitation on echocardiography.

Conclusions: Repair of adult tetralogy of Fallot has acceptable morbidity and mortality rates with good long-term surgical outcome in terms of effort tolerance as demonstrated by treadmill testing. Transannular patching does not appear to be a significant risk factor for right ventricular failure at long-term follow-up.

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Invited commentary

Jürgen Hörer and Christian Schreiber
Ann. Thorac. Surg. 2007 83: 1795-1796. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				J. Horer and C. Schreiber Invited commentary Ann. Thorac. Surg., May 1, 2007; 83(5): 1795 - 1796. [Full Text] [PDF]