Circulation, Vol 77, 1062-1067, Copyright © 1988 by American Heart Association
EP Walsh, S Rockenmacher, JF Keane, TJ Hougen, JE Lock and AR Castaneda
Between 1973 and 1985, 220 infants (age 1 day to 18 months, mean = 7
months) underwent repair of tetralogy of Fallot (TOF) or TOF/pulmonary
atresia with 17 early deaths. Follow-up status was ascertained for 184 of
203 survivors (91%) at a postoperative interval of 2 to 185 months (mean =
60 months). Significant residual hemodynamic lesions included ventricular
septal defect in three, and right ventricular outflow gradient in excess of
40 mm Hg in 24. Reoperation or interventional catheter procedures were
performed in 31 of 184 (17%) patients. All postoperative electrocardiograms
were reviewed; only two of 184 patients had ventricular ectopy on any
tracing. Holter data from 41 patients revealed one with sinus node
dysfunction, 12 with Lown grade 1 ectopy, and one with Lown grade 2 or
greater. Conduction defects, evaluated by electrocardiographic and
electrophysiologic measurements, were not different from those reported for
TOF patients undergoing repair at later ages. No study patient received
antiarrhythmic medication, although one required a pacemaker for sinus node
dysfunction. There were three late deaths, all unrelated to arrhythmia. TOF
repair in infancy appears to be associated with an acceptable hemodynamic
outcome, and a low incidence of ventricular ectopy and sudden death at 5
year follow-up.
ARTICLES
Late results in patients with tetralogy of Fallot repaired during infancy
Department of Cardiology, Children's Hospital, Boston, MA 02115.
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