Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF)

Abstract

Restrictive RV physiology is inversely related to age at repair and independent of type of outflow tract repair. Since TAP repair is more common in early repair, and restriction seems to be less frequent, long-term follow-up to assess adverse effects of pulmonary regurgitation is mandatory.

Right ventricular diastolic dysfunction in the postoperative period of tetralogy of Fallot

“…Several studies have correlated preoperative and operative factors with restrictive right ventricular physiology; however, as in our study, few relevant data were found [1][2][3][4][5][6][7][8][9] . Restrictive right ventricular physiology may relate to a process of endomyocardial fibrosis intrinsic to the disease itself and intensified as time goes by 10 , to the ventriculotomy, and to the interposition of patches in the interventricular septum and in the infundibulum 3,4,6 .…”

“…Its prevalence in the literature ranges from 28 to 52% 3,6 . In our study, with an intermediate postoperative follow-up, 63.3% of the patients had this alteration.…”

“…Restrictive right ventricular physiology may relate to a process of endomyocardial fibrosis intrinsic to the disease itself and intensified as time goes by 10 , to the ventriculotomy, and to the interposition of patches in the interventricular septum and in the infundibulum 3,4,6 . It also seems to be influenced by immaturity of the right ventricle, which adapts to the aggressions of extracorporeal circulation, cardioplegia, and hypothermia 6,11,12 . Myocardial dysfunction related to age has been investigated by some authors.…”

“…Studies in the literature have shown that electrocardiographic, radiological, and clinical alterations may be related to the prognosis of the patient undergoing total repair of tetralogy of Fallot [1][2][3][4][5][6][7][8][9] . Biventricular systolic function is preserved in most patients [2][3][4] .…”

“…However, right ventricular diastolic function has been recently observed to show signs of impairment with a diverse behavior in different phases of the postoperative follow-up [2][3][4] . This way, restrictive right ventricular physiology may be related to a complicated evolution in the early postoperative period [2][3][4]6 , but on the other hand, to a more favorable course in the late postoperative period 3 . This study aimed to assess the clinical, electrocardiographic, and radiological factors related to right ventricular diastolic dysfunction in the intermediate postoperative period of the repair of tetralogy of Fallot.…”