Circulation, Vol 61, 1150-1158, Copyright © 1980 by American Heart Association
KM Borow, LH Green, AR Castaneda and JF Keane
Left ventricular (LV) work-function curves were used to assess LV
performance in eight postoperative tetralogy of Fallot (TOF) patients who
underwent repair before 2 years of age (group 1) and 12 patients who
underwent repair after 2 years of age (group 2). All patients were without
significant residual shunts or pulmonary stenosis. Results were compared
with those in seven control patients. Left- and right-heart hemodynamics
were measured at various levels of afterload induced by methoxamine while
heart rate was maintained constant. Cardiac output was serially measured.
The slope (m) for each patient's LV end- diastolic pressure (EDP) vs LV
minute-work index (MWI) relationship was determined. There were no
significant differences in resting cardiac index, LV systolic pressure,
LVEDP, aortic oxygen saturation or MWI among the groups. However, with
afterload stress, group 2 patients had abnormal work-function curves with
depressed slopes (m = 0.21 +/- 0.04) compared with the values for group 1
patients (m = 0.89 +/- 0.13, p less than 0.001) or the control group (m =
1.13 +/- 0.12, p less than 0.001). Thus, LV dysfunction unmasked by an
afterload stress was present in the older TOF patients but not in the
patients repaired during infancy. These findings raise the possibility that
early, definitive repair of TOF may help preserve postoperative LV
function.
ARTICLES
Left ventricular function after repair of tetralogy of fallot and its relationship to age at surgery
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