Results of total correction of the tetralogy of Fallot. Long-term haemodynamic evaluation at rest and during exercise.

Abstract

Postoperative haemodynamic evaluation was performed on 15 patients 7 to 14 years (mean, 11 years) after total intracardiac repair of Fallot's tetralogy. The average age of the patients at the time of postoperative catheterization was 20 years (range 12 to 29) and they were all asymptomatic. Before operation 11 patients were severely cyanosed and disabled and 4 had mild cyanosis with anoxic spells. The cardiac output and right heart pressures were measured at rest and after 5 minutes of submaximal exercise on a bicycle ergometer. It was shown that the degree of residual obstruction of the pulmonary outflow tract was slight and that the right ventricular/pulmonary arterial systolic gradient (RV/PA gradient) exceeded 20 mmHg (2-6 kPa) at rest in only 3 patients. The mean cardiac index at rest was 5-4 l min-1 m-2 which increased to 8-3 l min-1 m-2 during exercise. The response of the cardiac output during exercise was either normal or supranormal in 14 of the 15 patients. In the remaining patient the response was marginally below the normal range. Pulmonary valvular regurgitation was present in 8 patients but there was no detectable difference in the cardiac function of these patients compared with patients with competent pulmonary valves. Six of the patients investigated had also had cardiac catheterizations performed 1 to 4 years after operation. The results of the present study show that remarkably little change has occurred in their haemodynamic status in the intervening years. Though these results are encouraging, further studies are required to determine the eventual outcome of the RV pressure and volume overload.

Exercise MR Imaging in the Assessment of Pulmonary Regurgitation and Biventricular Function in Patients after Tetralogy of Fallot Repair

“…However, in the few studies in which investigators evaluated pulmonary hemodynamics after tetralogy of Fallot correction, no marked changes in pulmonary pressure were reported (40,41).…”

Correção intracardíaca da tetralogia de Fallot no primeiro ano de vida: resultados a curto e médio prazos

“…The late results of correction of tetralogy of Fallot in the first year of life have been analyzed under many different aspects and have proven to be excellent when compared to those seen in older children [27][28][29][30][31][32]. Van Arsdell et al [33] reviewed 227 consecutive cases of tetralogy of Fallot, all of which were operated at the Hospital for Sick Children in Toronto, and they concluded that the best survival and physiological result was obtained in children who received the operation between 3 and 11 months.…”

Exercise Capacity, Residual Abnormalities and Activity Habits following Total Correction for Tetralogy of Fallot

“…However, Finnegan et al (7) reported that little change occurred in the hemodynamic status of 6 patients with early (1 -4 years) versus late (7 -1 4 years) postoperative evaluations. Our results suggest that residual stenosis of the RVOT is related to the reduced exercise capacity in these patients.…”

“…Several postoperative studies have shown that the majority of patients can enjoy a normal life without symptoms (9,14) and have a fair tolerance to physical exercise (2,6,7,11,13,15). However, hemodynamic and angiographic studies at rest (3.…”