Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-13T00:59:41.917Z Has data issue: false hasContentIssue false
  • English
  • Français

Influence of early repair of tetralogy of Fallot without an outflow patch on late arrhythmias and sudden death: a 27-year follow-up study following a uniform surgical approach

Published online by Cambridge University Press:  30 July 2009

Hiromichi Hamada ,
Masaru Terai ,
Toshiaki Jibiki ,
Tsunetaro Nakamura ,
Michael A. Gatzoulis  and
Koichiro Niwa
Hiromichi Hamada*
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Masaru Terai
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Toshiaki Jibiki
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Tsunetaro Nakamura
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Michael A. Gatzoulis
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
Koichiro Niwa
Affiliation:
Department of Pediatrics and Cardiovascular surgery, Chiba Cardiovascular Center; Department of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Japan; and Adult Congenital Programme, Royal Brompton Hospital, London, UK
*
Department of Pediatrics, Graduate school of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan. Tel: +81 43 226 2144; Fax: +81 43 226 2145; E-mail: hiro@pediat3.m.chiba-u.ac.jp
Get access Rights & Permissions [Opens in a new window]

Abtsract

Pulmonary regurgitation and older age at the time of repair may have a large impact late after repair on subsequent mortality of patients with tetralogy of Fallot. We aimed to identify whether age at repair, and preservation of the pulmonary valve, had a favorable influence on morbidity and mortality. We also analyzed risk factors for late death subsequent to surgical repair. We identified 167 patients who, between 1965 and 1975, and at a mean age of 6 years, underwent total repair of tetralogy of Fallot by a single surgical team without use of an outflow patch. All patients were known to have survived for at least 30 days after repair, and late mortality was identified though the use of hospital records, interviews, and death certificates. The 29-year actuarial survival rate was 86%, with 24 late deaths. Of these deaths, seven occurred suddenly (4.2%). Morbidity was analyzed in 99 of the patients by means of a written questionnaire and telephone interview. It proved possible to analyze ventricular and valvar function in 50 of the patients. Survivors experienced no re-intervention, and 89% of them were in class I of the grading system of the New York Heart Association. We found evidence of 3 episodes of sustained ventricular tachycardia (3.0%), and two episodes of atrial tachycardia (2.0%). Of the 50 patients in whom serial examinations were available, 18 had pulmonary regurgitation of moderate degree or greater, and none had more than moderate tricuspid regurgitation, with a mean QRS duration of 148ms and an ejection fraction for the left ventricle of 50%. Older age at repair (p = 0.03), and longer periods of cardiac arrest during repair (p = 0.02), were associated with late mortality. Although the mortality was similar to that observed in previous reports, our operative method might have a better effect in terms of late morbidity.

Keywords

Sudden cardiac deathadult congenital heart diseasetransjunctional outflow patch
Type
Original Articles
Information
Cardiology in the Young , Volume 12 , Issue 4 , July 2002 , pp. 345 - 351
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Murphy, JG, Gersh, BJ, Mair, DD et al. , Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot. N Engl J Med 1993; 329: 593–599.CrossRefGoogle ScholarPubMed
2.Karl, TR, Sano, S, Pornviliwan, S, Mee, RBB.Tetralogy of Fallot: favorable outcome of non-neonatal transatrial, transpulmonary repair. Ann Thorac Surg 1992; 54: 903–907.CrossRefGoogle Scholar
3.Garson, A, Randall, DG, Gillete, PC et al. , Prevention of sudden death after repair of tetralogy of Fallot: treatment of ventricular arrhythmias. J Am Coll Cardiol 1985; 6: 221–227.CrossRefGoogle ScholarPubMed
4.Burns, RJ, Liu, PP, Druck, MN, Seawrite, SJ, Williams, WG, McLaughlin, PR.Analysis of adults with and without complex ventricular arrhythmias after repair of tetralogy of Fallot. J Am Coll Cardiol 1984; 4: 226–233.CrossRefGoogle ScholarPubMed
5.Bricker, JT.Sudden death and tetralogy of Fallot. Circulation 1995; 92: 162–163.Google Scholar
6.Rocchini, AP, Rosental, A, Freed, M, Castaneda, AR, Nadas, AS.Chronic congestive heart failure after repair of tetralogy of Fallot. Circulation 1977; 56: 305–310.CrossRefGoogle ScholarPubMed
7.Hu, DCK, Seward, JB, Puga, FJ, Fuster, V, Tajik, AJ.Total correction of tetralogy of Fallot at age 40 years and older: long-term follow-up. J Am Coll Cardiol 1985; 5: 40–44.Google Scholar
8.Katz, NM, Blackstone, EH, Kirklin, JW, Pacifico, AD, Bargeon, LM Jr. Late survival and symptoms after repair of tetralogy of Fallot. Circulation 1982; 65: 403–410.CrossRefGoogle ScholarPubMed
9.Gatzoulis, MA, Till, JA, Somerville, J, Redington, AN.Mechano-electrical interaction in tetralogy of Fallot: QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation 1995; 92:231–237.Google Scholar
10.Gatzoulis, MA, Balaji, S, Webber, SA et al. , Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 2000; 356: 975–981.Google Scholar
11.Harrison, DA, Harris, L, Siu, SC et al. , Sustained ventricular tachycardia in adult patients late after repair of tetralogy of Fallot. J Am Coll Cardiol 1997; 30: 1368–1373.CrossRefGoogle ScholarPubMed
12.Marie, PY, Marcon, F, Brunotte, F et al. , Right ventricular over-load and induced sustained ventricular tachycardia in operatively “repaired” tetralogy of Fallot. Am J Cardiol 1992; 69:785–789.CrossRefGoogle Scholar
13.Norgard, G, Gatzoulis, MA, Moraes, F et al. , Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot: implications for long-term outcome. Circulation 1996; 94: 3276–3280.CrossRefGoogle ScholarPubMed
14.Carvalho, JS, Shinebourne, EA, Busst, C, Redington, AN.Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J 1992; 67: 470–473.Google Scholar
15.Lowe, SA, Zahka, KG, Manolio, TA, Horneffer, PJ, Kidd, L.Lung function and pulmonary regurgitation limit exercise capacity in postoperative tetralogy of Fallot. J Am Coll Cardiol 1991; 17: 461–466.Google Scholar
16.Norgard, G, Bjorkhaug, A, Vik-Mo, H.Effects of impaired lung function and pulmonary regurgitation on maximal exercise capacity in repaired tetralogy of Fallot. Fur Heart J 1992; 13: 1380–1386.Google Scholar
17.Singh, GK, Greenberg, SB, Yap, YS, Delany, DP, Keeton, BR, Monro, JL.Right ventricular function and exercise performance late after primary repair of tetralogy of Fallot with the transannular patch in infancy. Am J Cardiol 1998; 81: 1378–1382.Google Scholar
18.Wessel, HU, Cunningham, WJ, Paul, MH, Bastainer, CK, Muster, AJ, Idriss, FS.Exercise performance in tetralogy of Fallot after intracardiac repair. J Thorac Cardiovasc Surg 1980; 80: 582–593.Google Scholar
19.Yemets, IM, Williams, WG, Webb, GD et al. , Pulmonary valve replacement late after repair of tetralogy of Fallot. Ann Thorac Surg 1998; 65: 889–890.Google Scholar
20.Ross, BA.From the bedside to the basic science laboratory: arrhythmias in Fallot's tetralogy. J Am Coll Cardiol 1993; 21: 1738–1740.CrossRefGoogle Scholar
21.Yamashita, J, Okamura, H, Yasuo, H.Total correction of Fallot's tetralogy in children under 5 years of age by simple deep hypo thermia. Heart (in Japanese) 1974; 7: 546–559.Google Scholar
22.Gatzoulis, MA, Clark, AL, Cullen, S, Newman, CGH, Redington, AN.Right ventricular diastolic function 15 to 35 years after repair of tetralogy of Fallot: restrictive physiology predicts superior exercise performance. Circulation 1995; 91: 1775–1781.CrossRefGoogle ScholarPubMed
23.Foale, R, Nihoyannopoulos, P, KcKenna, W et al. , Echocardio-graphic measurement of normal adult right ventricle. Br Heart J 1986; 56: 33–44.Google Scholar
24.Goldberg, SJ, Allen, HD.Quantitative assessment of Doppler echocardiography of pulmonary or aortic regurgitation. Am J Cardiol 1985; 56: 131–135.CrossRefGoogle ScholarPubMed
25.Suzuki, Y, Kambara, H, Kadota, K et al. , Detection and evaluation of tricuspid regurgitation using a real-time, two-dimensional, color-coded, Doppler flow imaging system: comparison with contrast two-dimensional echocardiography and right ventriculography. Am J Cardiol 1986; 57: 811–815.CrossRefGoogle ScholarPubMed
26.Figenbaum, H. Echocardiography. In: Braunwald, E (ed.). Heart Disease. W.B. Saunders Co, Philadelphia, 1997, pp 53–107.Google Scholar
27.Lillehei, CW, Warden, HE, DeWall, RA et al. , The first open heart corrections of tetralogy of Fallot. A 26–31 year follow-up of 106 patients. Ann Surg 1986; 204: 490–502.Google Scholar
28.Nollert, G, Fischlein, T, Bouterwek, S, Bohmer, C, Klinner, W, Reichart, B.Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 1997; 30: 1374–1383.CrossRefGoogle ScholarPubMed
29.Garson, A, Nihill, MR, McMamara, DG, Cooley, DA.Status of the adult and adolescent after repair of tetralogy of Fallot. Circulation 1979; 59: 1232–1240.Google Scholar
30.Fuster, V, McGoon, D, Kennedy, MA, Ritter, DG, Kirklin, JW.Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot. Am J Cardiol 1980; 46: 635–642.Google Scholar
31.Horneffer, PJ, Zahka, KG, Rowe, SA et al. , Long-term results of total repair of tetralogy of Fallot in childhood. Ann Thorac Surg 1990; 50: 179–185.Google Scholar
32.Klinner, W, Reichat, M, Pfaller, M, Hatz, R.Late results after correction of tetralogy of Fallot necessitating outflow tract reconstruction. Comparison with results after correction without outflow tract patch. Thorac Cardiovasc Surg 1984; 32: 244–247.Google Scholar
33.Zhao-, HX, Miller, DC, Reitz, BA, Shumway, NE.Surgical repair of tetralogy of Fallot: long-term follow-up with particular emphasis on late death and reoperation. J Thorac Cardiovasc Surg 1985; 89: 204–220.CrossRefGoogle ScholarPubMed
34.Chandar, JS, Wolff, GS, Garson, A et al. , Ventricular arrhythmias in postoperative tetralogy of Fallot. Am J Cardiol 1990; 65: 655–661.CrossRefGoogle ScholarPubMed
35.Roos-hesselink, J, Perlroth, MG, McGhie, J, Spitaels, S.Atrial arrhythmias in adults after repair of tetralogy of Fallot: correlations with clinical, exercise, and echocardiographic findings. Circulation 1995; 91: 2214–2219.CrossRefGoogle ScholarPubMed
36.IIIDodds, GA, Warnes, CA, Danielson, GK.Aortic valve replacement after repair of pulmonary atresia and ventricular septal defect or tetralogy of Fallot. J Thorac Cardiovasc Surg 1997; 113: 736–741CrossRefGoogle ScholarPubMed
37.Niwa, K, Perloff, JK, Bhuta, SM et al. , Structural abnormalities of great arterial walls in congenital heart disease. Circulation 2001; 103: 393–400.CrossRefGoogle ScholarPubMed
38.Marsalese, DL, Moodie, DS, Lytle, BW et al. , Cystic media necrosis of the aorta in patients without Marfan's syndrome: surgical outcome and long-term follow-up. J Am Coll Cardiol 1990; 16: 68–73.CrossRefGoogle Scholar
39.Borow, KM, Green, LH, Castaneda, AR, Keane, AF.Left ventricular function after repair of tetralogy of Fallot and its relationship to age at surgery. Circulation 1980; 61: 1150–1158.Google Scholar