Pediatric cardiology
Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of fallot

https://doi.org/10.1016/0002-9149(80)90514-7Get rights and content

Abstract

Four hundred seventy-five patients underwent repair of tetralogy of Fallot from 1955 to 1964; 396 of these were hospital survivors and were followed up for 12 to 22 years. An excellent late clinical result was maintained by 87 percent of the 396 hospital survivors. A less than excellent result in the remaining 13 percent of hospital survivors was caused by late mortality in 7 percent (sudden death in 3 percent, death due to cardiac causes in 2 percent and death due to noncardiac causes in 2 percent), required reoperation in 4 percent (mainly because of residual ventricular septal defect) and development of symptoms in 2 percent.

Postoperative cardiomegaly (cardiothoracic ratio greater than 0.55) was observed in 60 (25 percent) of 246 patients who had a follow-up chest roentgenogram, and was more common among those who died late or remained symptomatic. Among the few patients with inadequate surgical relief of right ventricular hypertension who did not have transanular patch repair, the hypertension did not tend to decrease progressively, whereas it did decrease in patients who had patch repair. No late sudden deaths were encountered in 20 patients shown to have postoperative right bundle branch block plus left axis deviation (bifascicular block pattern). Pulmonary valve incompetence appeared to have relatively little harmful influence on the late result, causing cardiac disability in 1 percent of the patients and appeared to be the main contributing factor of postoperative cardiomegaly in 13 (5 percent) of the 246 patients who had a follow-up chest roentgenogram. Most late deaths and complications appeared within 2 years of operation, and accelerating deterioration in late results did not occur as the follow-up extended beyond 2 decades.

References (35)

  • S Kaplan

    Long-term results after surgical treatment of congenital heart disease

    Mod Concepts Cardiovasc Dis

    (1977)
  • A Blalock et al.

    The surgical statement of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia

    JAMA

    (1945)
  • WJ Potts et al.

    Anastomosis of the aorta to a pulmonary artery

    JAMA

    (1946)
  • RC Brock

    The surgery of pulmonary stenosis

    Br Med J

    (1949)
  • P Armeleage

    Tests for linear trends on proportions and frequencies

    Biometrics

    (1955)
  • A Garson et al.

    Status of the adult and adolescent after repair of tetralogy of Fallot

    Circulation

    (1979)
  • FW James et al.

    Response to exercise in patients after total surgical correction of tetralogy of Fallot

    Circulation

    (1976)
  • Cited by (175)

    • Huge right ventricular outflow tract aneurysm late following total repair of tetralogy of Fallot leading to orthotopic heart transplantation

      2021, Cardiovascular Pathology
      Citation Excerpt :

      Each of the 3 patients described developed huge RVOT aneurysms involving the transannular patches decades after the operative correction of T of F. Calcific deposits developed in the parietal pericardial patches of all 3 patients, minimal in one and massive in 2. Confirmation of the presence of calcific deposits in the patches has been infrequent [2–7]. Calcific deposits in the patch can develop relatively early after its insertion.

    • Right ventricular restrictive physiology in repaired tetralogy of Fallot is associated with smaller respiratory variability

      2008, International Journal of Cardiology
      Citation Excerpt :

      Primary repair of tetralogy of Fallot (TOF) has been performed with low risk and acceptable long-term results for more than several decades. On the other hand, reports concerning the late mortality and functional deterioration on long-term follow-up are emerging [1–10] and it has been well documented that the long-term outcome of patients with repaired TOF is related to right ventricular (RV) volume overload, severity of pulmonary insufficiency (PI) and the type of outflow repair [1–8,10–12]. Recently, a new concept of restrictive right ventricular physiology (RVRP) in repaired TOF patients had been introduced and known to be related to less RV dilatation, less prolongation of QRS duration, less symptomatic ventricular arrhythmia, and more favorable late outcome [9,13,14], but some conflicting results [15–17] have also been reported, and the relationships among the influencing factors are not clearly understood.

    View all citing articles on Scopus
    View full text