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(Circulation. 1995;92:158-159.)
© 1995 American Heart Association, Inc.
Articles |
Sudden Death and Tetralogy of Fallot
Risks, Markers, and Causes
From Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, and the Texas Heart Institute, Houston.
Correspondence to J. Timothy Bricker, MD, Chief, Pediatric Cardiology, Texas Children's Hospital, 6621 Fannin, Suite 260, Houston, TX 77030.
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Introduction |
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Tetralogy of Fallot has been treated with palliative surgery for more than 50 years, and operative correction has been available for more than 30 years. Although surgical repair is now done with low mortality and excellent quality of survival, late sudden cardiac death remains a problem.1 2 Understanding of the causes and of the factors that predict risk for sudden death remains incomplete.
Observations by astute clinicians in the first half of this century suggested possible causes of coronary artery disease. White3 thought that tobacco was probably without influence on the development of coronary disease. It was believed that overworked business or professional men were more likely to have coronary symptoms3 and that environmental noise as well as a stressful environment might contribute to the risk of developing coronary artery disease.4
The term "cohors" referred to 1/10 of a Roman legion. Each
cohort
in the legion included 300 to 600 soldiers who would march together in
defense of the empire. Initially, the use of this term in
epidemiology referred to a birth cohort (eg,
all children with heart disease born in 1950). Now, the term cohort
often refers to any group of individuals followed longitudinally and
who are "marching through time" together. Beginning in the 1940s,
several large cohorts at risk for development of
symptomatic coronary artery disease were carefully
observed in a systematic manner.5
Multivariate analysis of numerous candidate
variables for development of coronary artery disease in
these cohorts led to our current understanding of coronary risk
factors. A variable
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