Postoperative Long-Term Results in Total Correction of Tetralogy of Fallot: Hemodynamics and Cardiac Function

Late results were assessed in 63 patients who underwent complete repair of tetralogy of Fallot. These patients were divided into four groups. Group I-A included 13 who had a transannular patch with a monocusp, and whose cross-sectional area index (CSAI) was less than 2.5 cm 2/m 2; group I-B included 11 with the patch and with a CSAI greater than 2.5 cm 2/m 2. Group II included 27 patients who underwent pulmonary valvotomy. Group III included 9 who had not undergone valvotomy and 3 who had undergone pulmonary valve replacement. Late death occurred in 1 patient, and reoperation was done on 3. Mild pulmonary stenosis (PS) was present in 73%, moderate PS in 17%, and severe PS in 10% of the patients. A significant pulmonary regurgitation (PR) of grade 3 or 4 was present in 33% of the patients in group I-A, and in 87% of group I-B, 17% of group II, and 0% of group III. Right ventricular end-diastolic volume was normal in patients with a PR of grade 2 or less, and it was higher in patients who had a significant PR. The ejection fraction was generally decreased, regardless of the grade of PR. Left ventricular function was normal in those with a PR of grade 3 or less and was impaired in those with a PR of grade 4. Thus, late postoperative hemodynamics and ventricular function were excellent in patients with a mild PS and a PR of grade 2 or less, and it was poor in those with a moderate PS and a significant PR. To prevent significant PR, enforced blunt enlargement of the pulmonary annulus should be avoided, and when a transannular patch is used, the CSAI should be 1.75 to 2.5 cm 2/m 2. Coaptation between the autopulmonary cusp and the cusp attached to the patch should be done.