HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Fernando A. Atik Luiz Fernando Caneo Marcelo B. Jatene Arlindo Riso Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Atik, F. A. Articles by Barbero-Marcial, M. Search for Related Content PubMed PubMed Citation Articles by Atik, F. A. Articles by Barbero-Marcial, M. Related Collections Congenital - cyanotic

Eur J Cardiothorac Surg 2004;25:250-255
© 2004 Elsevier Science NL

Long-term results of correction of tetralogy of Fallot in adulthood

Department of Pediatric Cardiac Surgery and Pediatric Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo, SP, Brazil

Received 7 July 2003; received in revised form 5 October 2003; accepted 11 November 2003.

^* Corresponding author. Tel.: +55-11-328-56-366; fax: +55-11-328-56-366
e-mail: conatik{at}incor.usp.br

Objective: The natural history of tetralogy of Fallot (TOF) allows that a minority of patients reach adulthood without any treatment, representing mild forms of the disease. The aim of this study is the long-term evaluation of patients with TOF surgically treated in adulthood, in order to define its real benefit. Methods: Between November 1982 and January 2001, 39 patients older than 18 years of age with tetralogy of Fallot underwent total correction. Mean age was 26.6 years (range 18–67) and 21 patients (53.8%) were females. A previous modified Blalock–Taussig shunt was performed in four patients (10.3%). Fifteen patients (38.5%) were in NYHA functional class III or IV. Mean hematocrit was 53.6±10% and the mean gradient across the right-ventricular outflow tract was 93.9±24.8 mmHg. The operation was performed via transatrial/transpulmonary approach in 16 patients (41%) and six patients (15.4%) required transannular patch. Pulmonary valvotomy was necessary in 13 patients (33.3%) and pulmonary valve replacement with bioprosthesis in 3 patients (7.7%). Results: Hospital and late mortality were 5.1 and 7.7%, respectively. The mean follow-up was 45.1 months (range 1–194 months). Actuarial survival was 91.2±4.9%, 85.5±7.2% and 68.4±16.3% at 3, 7 and 15 years, respectively. In the latest follow-up, 27 (79.4%) of the survivals are presently in NYHA functional class I (P<0.001). Echocardiography has shown moderate/severe pulmonary insufficiency in 9 patients (26.5%), moderate pulmonary stenosis in 3 patients (8.8%) and residual ventricular septal defect in 4 patients (11.8%). Arrhythmias were identified in 38.9% of patients with symptoms suspicious of rhythm disturbances. There was impairment of right-ventricular function in 13 patients (38.2%). Three patients were reoperated on to close residual ventricular septal defects in two patients and for pulmonary valve replacement in one patient. Conclusions: The overall survival of surgically treated adult patients with TOF is acceptable. The great benefit of the complete repair at this age is the functional improvement. On the other hand, late complications closely related to chronic hypoxia, such as arrhythmia and ventricular dysfunction might direct for a more careful follow-up after the surgical correction.

Key Words: Tetralogy of Fallot • Cyanosis • Congenital heart disease

This article has been cited by other articles:

				C A C Pedra, J Haddad, S F Pedra, A Peirone, C B Pilla, and J A Marin-Neto Paediatric and congenital heart disease in South America: an overview Heart, September 1, 2009; 95(17): 1385 - 1392. [Abstract] [Full Text] [PDF]

				F. Haddad, P. Couture, C. Tousignant, and A. Y. Denault The Right Ventricle in Cardiac Surgery, a Perioperative Perspective: II. Pathophysiology, Clinical Importance, and Management Anesth. Analg., February 1, 2009; 108(2): 422 - 433. [Abstract] [Full Text] [PDF]

				S. Rosianu, D. Paprika, I. Osztheimer, A. Temesvari, and T. Szili-Torok Echocardiographic evaluation of patients with undocumented arrhythmias occurring in adults late after repair of tetralogy of Fallot Eur J Echocardiogr, January 1, 2009; 10(1): 139 - 143. [Abstract] [Full Text] [PDF]

				R. J. Sommer, Z. M. Hijazi, and J. F. Rhodes Pathophysiology of Congenital Heart Disease in the Adult: Part III: Complex Congenital Heart Disease Circulation, March 11, 2008; 117(10): 1340 - 1350. [Full Text] [PDF]

				A. Sadiq, K. G. Shyamkrishnan, S. Theodore, S. Gopalakrishnan, J. M. Tharakan, and J. Karunakaran Long-Term Functional Assessment After Correction of Tetralogy of Fallot in Adulthood Ann. Thorac. Surg., May 1, 2007; 83(5): 1790 - 1795. [Abstract] [Full Text] [PDF]

				J. Horer, J. Friebe, C. Schreiber, M. Kostolny, J. Cleuziou, K. Holper, and R. Lange Correction of Tetralogy of Fallot and of Pulmonary Atresia with Ventricular Septal Defect in Adults Ann. Thorac. Surg., December 1, 2005; 80(6): 2285 - 2291. [Abstract] [Full Text] [PDF]

				A. T. Lovell Anaesthetic implications of grown-up congenital heart disease Br. J. Anaesth., July 1, 2004; 93(1): 129 - 139. [Abstract] [Full Text] [PDF]