Surgical Repair of Tetralogy of Fallot in Adolescents and Adults

Summary

Of our total series of 248 patients with tetralogy of Fallot who underwent surgical repair between 1970 and 1980, 19 patients (7.6%) were between 16 and 55 years of age. Four of the 6 palliated patients developed pulmonary hypertension between 44 and 95 mmHg (mean 63.50 ± 22.04 mmHg). There was evidence of impaired right and left ventricular function in 7 patients (36%). The mean post-repair PRV/PLV was 0.37 ± 0.08 in 12 patients, 0.63 ± 0.04 in 6 patients, and 0.8 in one patient. There were 2 hospital deaths and 2 late deaths one and 5 years, respectively, after surgery. Five patients were available for post-repair hemodynamic assessment with follow-up periods of 1/2 to 6 years (mean 2.78 ± 1.76 years). Eight patients improved from New York Heart Association (NYHA) functional class III to II, 2 patients from class IV to III, and 5 remained in their preoperative class III. Pulmonary regurgitation was evident in the patients who received transannular patches as well as those with valvotomies. The mean postoperative right and left enddiastolic pressures were 17.2 ± 6.30 mmHg and 16.5 ± 4.50 mmHg respectively, indicating further impairment of myocardial function. Our results demonstrate that advancing age per se is not a contraindication for surgical repair of tetralogy of Fallot. However, the latent impaired myocardium cannot tolerate permanent volume load with or without pulmonary hypertension for a follow-up period of up to 6 years. This is shown by the fact that though the patients improved clinically by one class in the NYHA functional classification, they did not become asymptomatic. Therefore surgical repair of tetralogy of Fallot, though feasible in adults, is recommended to be performed at a younger age.

Key words

Tetralogy of Fallot - Adolescents and adults - Postoperative clinical and hemodynamic results