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The Journal of Thoracic and Cardiovascular Surgery, Vol 85, 691-696, Copyright © 1983 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
EL Bove, CJ Byrum, FD Thomas, RE Kavey, HM Sondheimer, MS Blackman and FB Parker Jr
Long-standing pulmonary insufficiency after repair of tetralogy of Fallot
may adversely affect ventricular function. We evaluated 20 patients at a
mean of 9 years after repair by radionuclide ventriculography, 24 hour
Holter monitoring, and M-mode echocardiography. The mean age at complete
repair was 7.1 +/- 2.6 years. Patients were divided into groups as follows:
Group I (eight patients), no clinical pulmonary insufficiency; Group II (12
patients), moderate to severe pulmonary insufficiency. Group II was further
divided: Group IIa, transannular patch (six patients); Group IIb, no
transannular patch (six patients). There was no difference between groups
for age at operation, duration of follow-up, right ventricular pressure, or
right ventricular-pulmonary arterial gradient. No patient had a residual
shunt and all were in New York Heart Association Class I. Serious
ventricular dysrhythmias occurred in 38% of Group I patients and 50% of
Group II (p = NS). The echocardiographic ratio of right to left ventricular
end-diastolic dimension was greater in patients with pulmonary
insufficiency than in those without pulmonary insufficiency: 0.83 +/- 0.17
versus 0.55 +/- 0.15, p less than 0.01. Right ventricular ejection fraction
was 0.39 +/- 0.08 in Group I and 0.27 +/- 0.07 in Group II, p less than
0.01. Left ventricular ejection fraction was 0.64 +/- 0.12 in Group I and
0.53 +/- 0.07 in Group II, p less than 0.02. Radionuclide angiography is a
useful means of identifying right ventricular dysfunction following repair
of tetralogy of Fallot. The dysfunction appears significantly worse in
patients with pulmonary insufficiency.
ARTICLES
The influence of pulmonary insufficiency on ventricular function following repair of tetralogy of Fallot. Evaluation using radionuclide ventriculography
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