Midterm Evaluation of Residual Pulmonary Valve Dysfunction after Repair of Tetralogy of Fallot

All articles of this category Background: After repair of tetralogy of Fallot (TOF), residual right ventricular outflow tract obstruction (RVOT), and pulmonary valve dysfunction can occur and might lead to redo surgery or intervention. However, data on progression of residual pulmonary valve dysfunction in repaired Fallot are currently limited. Therefore, we sought to assess the evolution of RVOT gradients and grade of pulmonary valve regurgitation between discharge after TOF repair and midterm follow-up. Method: All consecutive TOF patients who underwent surgical repair at our institution from January 2004 to March 2022 were identified. Surgical repair consisted of VSD closure, resection of hypertrophic muscle bundles at the RVOT, and enlargement of the right-ventricle to pulmonary-artery segment using an annulus sparing technique or implantation of a transanular patch. Echocardiographic parameters including RVOT gradients (mean pressure gradient in mmHg) and grade of pulmonary valve regurgitation (none = 0; mild = 1; moderate = 2; severe = 3) were assessed at discharge and yearly during follow-up. Echocardiographic findings following reoperation or intervention of the RVOT were excluded. Statistical analysis was performed by Wilcoxon rank sum test. Results: A total of 192 patients were included. Mean age at TOF repair was 7.2 ± 6.6 months. Mean follow-up time was 7.2 ± 5.1 years. The mean RVOT gradient of all patients showed a mild, but significant decrease between discharge and follow-up (26 ± 13 mm Hg vs. 23 ± 16 mm Hg; p = 0.003). Subgroup analysis of patients with a postoperative RVOT gradient > 30 mm Hg ( n = 75; 39%) revealed a significant decrease of mean RVOT gradient over time (38 ± 10 mm Hg vs. 27 ± 17 mm Hg; p < 0.001). Grade of pulmonary valve regurgitation showed no progression during follow-up (at discharge: grade 2.1 vs. at follow-up: grade 2.1; p = 0.8). Conclusion: Following repair of TOF, RVOT gradients and grade of pulmonary valve regurgitation remained stable in the midterm. Even in patients with a residual RVOT obstruction > 30 mm Hg, a significant decrease of mean pressure gradients was found without reinterventions. Hence, residual gradients can be accepted postoperatively to avoid free pulmonary regurgitation. Publication History Article published online: 28 January 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany