Long-term Outcomes of Surgical Repair of Tetralogy of Fallot_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HUZhi-wei ,  DONGNian-guo

Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, P. R. China;

Corresponding author：

DONGNian-guo, Email: dongnianguo@hotmail.com

Keywords：

Pulmonary valve; Arrhythmia; Long-term outcome; Tetralogy of Fallot

DOI：

10.7507/1007-4848.20140154

Video：

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Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. It is characterized by an interventricular communication with an overriding aorta, subpulmonary obstruction, and consequent right ventricular hypertrophy. The potential for late complications is an important concern for growing number of survivors after surgical repair, although long-term survival rates are excellent. Progressive pulmonary valve regurgitation leading to right heart failure and arrhythmias are common late complications and major reasons of mortality. In this review, we focus on research progress of pathogenesis and treatment of late complications after TOF repair, and the importance of long-term follow-up is emphasized.

Citation： HUZhi-wei, DONGNian-guo. Long-term Outcomes of Surgical Repair of Tetralogy of Fallot. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 548-551. doi: 10.7507/1007-4848.20140154 Copy

1.	Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med, 1993, 329 (9):593-599.
2.	Opotowsky AR, Siddiqi OK, Webb GD. Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol, 2009, 54 (5):460-467.
3.	Therrien J, Marx GR, Gatzoulis MA. Late problems in tetralogy of Fallot-recognition, management, and prevention. Cardiol Clin, 2002, 20 (3):395-404.
4.	Van Praagh R, Van Praagh S, Nebesar RA, et al. Tetralogy of fallot:underdevelopment of the pulmonary infundibulum and its sequelae. Am J Cardiol, 1970, 26 (1):25-33.
5.	Anderson RH, Jacobs ML. The anatomy of tetralogy of Fallot with pulmonary stenosis. Cardiol Young, 2008, 18 (Suppl.3):12-21.
6.	Anderson RH, Spicer DE, Giroud JM, et al. Tetralogy of fallot:nosological, morphological, and morphogenetic considerations. Cardiol Young, 2013, 23 (6):858-866.
7.	Hickey EJ, Veldtman G, Bradley TJ, et al. Functional health status in adult survivors of operative repair of tetralogy of fallot. Am J Cardiol, 2012, 109 (6):873-880.
8.	Kirklin Jw WR, Late Results After Intracardiac Repair of Fallot:5-year Review of 337 Patients. Ann Surg, 1965, 162:578-589.
9.	Nollert G, Fischlein T, Bouterwek S, et al. Long-term survival in patients with repair of tetralogy of Fallot:36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol, 1997, 30 (5):1374-1383.
10.	Lindberg HL, Saatvedt K, Seem E, et al. Single-center 50 years' experience with surgical management of tetralogy of Fallot. Eur J Cardiothorac Surg, 2011, 40 (3):538-542.
11.	Gerling C, Rukosujew A, Kehl HG, et al. Do the age of patients with tetralogy of fallot at the time of surgery and the applied surgical technique influence the reoperation rate? a single-center experience. Herz, 2009, 34 (2):155-160.
12.	Oechslin EN, Harrison DA, Harris L, et al. Reoperation in adults with repair of tetralogy of fallot:indications and outcomes. J Thorac Cardiovasc Surg, 1999, 118 (2):245-251.
13.	Park CS, Lee JR, Lim HG, et al. The long-term result of total repair for tetralogy of Fallot. Eur J Cardiothorac Surg, 2010, 38 (3):311-317.
14.	Le GL, Khairy P. Maagement of arrhythmias in patients with tetralogy of Fallot. Curr Opin Cardiol, 2011, 26:60-65.
15.	Khairy P, Aboulhosn J, Gurvitz MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot:a multiinstitutional study. Circulation, 2010, 122:868-875.
16.	Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot:a multicentre study. Lancet, 2000, 356 (9234):975-981.
17.	Mahle WT, Parks WJ, Fyfe DA, et al. Tricuspid regurgitation in patients with repaired Tetralogy of Fallot and its relation to right ventricular dilatation. Am J Cardiol, 2003, 92 (5):643-645.
18.	Uebing A, Fischer G, Bethge M, et al. Influence of the pulmonary annulus diameter on pulmonary regurgitation and right ventricular pressure load after repair of tetralogy of Fallot. Heart, 2002, 88 (5):510-514.
19.	Yoo BW, Kim JO, Kim YJ, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg, 2012, 143 (6):1299-1304.
20.	Kaushal SK, Radhakrishanan S, Dagar KS, et al. Significant intraoperative right ventricular outflow gradients after repair for tetralogy of Fallot:to revise or not to revise? Ann Thorac Surg, 1999, 68 (5):1705-1713.
21.	Alexiou C, Chen Q, Galogavrou M, et al. Repair of tetralogy of Fallot in infancy with a transventricular or a transatrial approach. Eur J Cardiothorac Surg, 2002, 22 (2):174-183.
22.	Frigiola A, Hughes M, Turner M, et al. Physiological and phenotypic characteristics of late survivors of tetralogy of fallot repair who are free from pulmonary valve replacement. Circulation, 2013, 128 (17):1861-1868.
23.	Oosterhof T, van Straten A, Vliegen HW, et al. Preoperative thresh-olds for pulmonary valve replacement in patients with corrected tetra-logy of Fallot using cardiovascular magnetic resonance. Circulation, 2007, 116 (5):545-551.
24.	Tweddell JS, Simpson P, Li SH, et al. Timing and technique of pulmonary valve replacement in the patient with tetralogy of fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15 (1):27-33.
25.	Broberg CS, Aboulhosn J, Mongeon FP, et al. Alliance for adult research in congenital cardiology (AARCC). prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of fallot. Am J Cardiol, 2011, 107 (8):1215-1220.
26.	Geva T, Sandweiss BM, Gauvreau K, et al. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol, 2004, 43 (6):1068-1074.
27.	Lu JC, Cotts TB, Agarwal PP, et al. Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of fallot. Am J Cardiol, 2010, 106 (12):1798-1802.
28.	Samman A, Schwerzmann M, Balint OH, et al. Exercise capacity and biventricular function in adult patients with repaired tetralogy of Fallot. Am Heart J, 2008, 156 (1):100-105.
29.	Gatzoulis M, Till JA, Somerville J, et al. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death.Circulation, 1995, 92:231-237.
30.	Beekman RP, Beek F, Meijboom EJ. Usefulness of MRI for the pre-operative evaluation of the pulmonary arteries in Tetralogy of Fallot. Magn Reson Imaging, 1997, 15 (9):1005-1015.
31.	Karamlou T, Mccrindle BW, Williams WG. Surgery insight:late complications following repair of tetralogy of Fallot and related surg-ical strategies for management. Nat Clin Pract Cardiovasc Med, 2006, 3 (11):611-622.
32.	Geva T. Tetralogy of fallot repair:ready for a new paradigm. J Thorac Cardiovasc Surg, 2012, 143 (6):1305-1306.

1. Murphy JG, Gersh BJ, Mair DD, et al. Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med, 1993, 329 (9):593-599.
2. Opotowsky AR, Siddiqi OK, Webb GD. Trends in hospitalizations for adults with congenital heart disease in the U.S. J Am Coll Cardiol, 2009, 54 (5):460-467.
3. Therrien J, Marx GR, Gatzoulis MA. Late problems in tetralogy of Fallot-recognition, management, and prevention. Cardiol Clin, 2002, 20 (3):395-404.
4. Van Praagh R, Van Praagh S, Nebesar RA, et al. Tetralogy of fallot:underdevelopment of the pulmonary infundibulum and its sequelae. Am J Cardiol, 1970, 26 (1):25-33.
5. Anderson RH, Jacobs ML. The anatomy of tetralogy of Fallot with pulmonary stenosis. Cardiol Young, 2008, 18 (Suppl.3):12-21.
6. Anderson RH, Spicer DE, Giroud JM, et al. Tetralogy of fallot:nosological, morphological, and morphogenetic considerations. Cardiol Young, 2013, 23 (6):858-866.
7. Hickey EJ, Veldtman G, Bradley TJ, et al. Functional health status in adult survivors of operative repair of tetralogy of fallot. Am J Cardiol, 2012, 109 (6):873-880.
8. Kirklin Jw WR, Late Results After Intracardiac Repair of Fallot:5-year Review of 337 Patients. Ann Surg, 1965, 162:578-589.
9. Nollert G, Fischlein T, Bouterwek S, et al. Long-term survival in patients with repair of tetralogy of Fallot:36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol, 1997, 30 (5):1374-1383.
10. Lindberg HL, Saatvedt K, Seem E, et al. Single-center 50 years' experience with surgical management of tetralogy of Fallot. Eur J Cardiothorac Surg, 2011, 40 (3):538-542.
11. Gerling C, Rukosujew A, Kehl HG, et al. Do the age of patients with tetralogy of fallot at the time of surgery and the applied surgical technique influence the reoperation rate? a single-center experience. Herz, 2009, 34 (2):155-160.
12. Oechslin EN, Harrison DA, Harris L, et al. Reoperation in adults with repair of tetralogy of fallot:indications and outcomes. J Thorac Cardiovasc Surg, 1999, 118 (2):245-251.
13. Park CS, Lee JR, Lim HG, et al. The long-term result of total repair for tetralogy of Fallot. Eur J Cardiothorac Surg, 2010, 38 (3):311-317.
14. Le GL, Khairy P. Maagement of arrhythmias in patients with tetralogy of Fallot. Curr Opin Cardiol, 2011, 26:60-65.
15. Khairy P, Aboulhosn J, Gurvitz MZ, et al. Arrhythmia burden in adults with surgically repaired tetralogy of Fallot:a multiinstitutional study. Circulation, 2010, 122:868-875.
16. Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot:a multicentre study. Lancet, 2000, 356 (9234):975-981.
17. Mahle WT, Parks WJ, Fyfe DA, et al. Tricuspid regurgitation in patients with repaired Tetralogy of Fallot and its relation to right ventricular dilatation. Am J Cardiol, 2003, 92 (5):643-645.
18. Uebing A, Fischer G, Bethge M, et al. Influence of the pulmonary annulus diameter on pulmonary regurgitation and right ventricular pressure load after repair of tetralogy of Fallot. Heart, 2002, 88 (5):510-514.
19. Yoo BW, Kim JO, Kim YJ, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardiovasc Surg, 2012, 143 (6):1299-1304.
20. Kaushal SK, Radhakrishanan S, Dagar KS, et al. Significant intraoperative right ventricular outflow gradients after repair for tetralogy of Fallot:to revise or not to revise? Ann Thorac Surg, 1999, 68 (5):1705-1713.
21. Alexiou C, Chen Q, Galogavrou M, et al. Repair of tetralogy of Fallot in infancy with a transventricular or a transatrial approach. Eur J Cardiothorac Surg, 2002, 22 (2):174-183.
22. Frigiola A, Hughes M, Turner M, et al. Physiological and phenotypic characteristics of late survivors of tetralogy of fallot repair who are free from pulmonary valve replacement. Circulation, 2013, 128 (17):1861-1868.
23. Oosterhof T, van Straten A, Vliegen HW, et al. Preoperative thresh-olds for pulmonary valve replacement in patients with corrected tetra-logy of Fallot using cardiovascular magnetic resonance. Circulation, 2007, 116 (5):545-551.
24. Tweddell JS, Simpson P, Li SH, et al. Timing and technique of pulmonary valve replacement in the patient with tetralogy of fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu, 2012, 15 (1):27-33.
25. Broberg CS, Aboulhosn J, Mongeon FP, et al. Alliance for adult research in congenital cardiology (AARCC). prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of fallot. Am J Cardiol, 2011, 107 (8):1215-1220.
26. Geva T, Sandweiss BM, Gauvreau K, et al. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol, 2004, 43 (6):1068-1074.
27. Lu JC, Cotts TB, Agarwal PP, et al. Relation of right ventricular dilation, age of repair, and restrictive right ventricular physiology with patient-reported quality of life in adolescents and adults with repaired tetralogy of fallot. Am J Cardiol, 2010, 106 (12):1798-1802.
28. Samman A, Schwerzmann M, Balint OH, et al. Exercise capacity and biventricular function in adult patients with repaired tetralogy of Fallot. Am Heart J, 2008, 156 (1):100-105.
29. Gatzoulis M, Till JA, Somerville J, et al. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death.Circulation, 1995, 92:231-237.
30. Beekman RP, Beek F, Meijboom EJ. Usefulness of MRI for the pre-operative evaluation of the pulmonary arteries in Tetralogy of Fallot. Magn Reson Imaging, 1997, 15 (9):1005-1015.
31. Karamlou T, Mccrindle BW, Williams WG. Surgery insight:late complications following repair of tetralogy of Fallot and related surg-ical strategies for management. Nat Clin Pract Cardiovasc Med, 2006, 3 (11):611-622.
32. Geva T. Tetralogy of fallot repair:ready for a new paradigm. J Thorac Cardiovasc Surg, 2012, 143 (6):1305-1306.

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