Long-Term Functional Assessment After Correction of Tetralogy of Fallot in Adulthood

Surgical repair of tetralogy of Fallot in a 78-year-old woman: a case report

BACKGROUND

Tetralogy of Fallot is a congenital heart disease mostly diagnosed and treated in early childhood. However, there are some adult cases receiving treatment.

CASE PRESENTATION

We describe a 78-year-old Japanese woman who presented with severely hypertrophic right ventricle, ventricular septum defect, overriding aorta, and severe infundibular stenosis in the right ventricular outflow tract. As hypoxemia was mild and daily exertion was sufficiently possible, home oxygen therapy was introduced. After 1 month, she was referred because of a positive blood culture. The blood culture test was positive four times, therefore, the antibacterial drug was administered according to active infective endocarditis. SpO2 repeatedly decreased during hospitalization, thus oxygen was needed. As there were infective endocarditis onset and progressive hypoxemia, we planned a surgical correction.

CONCLUSION

Tetralogy of Fallot was diagnosed and successfully treated with complete surgical correction, and the development of infective endocarditis was the definitive indication for surgery at this late age.

Surgical Treatment of Adults with Uncorrected Tetralogy of Fallot: A Clinical Case Series

The tetralogy of Fallot is the most common form of cyanotic congenital heart malformations. However, its association with Down syndrome is uncommon. We present two patients with uncorrected during childhood tetralogy of Fallot. One of them had also Down syndrome. We performed a complete surgical correction: closure of the inter-ventricular defect, right ventricular outflow tract reconstruction, pulmonary valve prosthesis and pulmonary artery patch repair (in one of the cases). The postoperative period was uncomplicated, patients were discharged on days 12 and 10, and the follow-up showed a significant functional class improvement.

Aortopathy in tetralogy of Fallot-a collective review

The pathophysiology of aortic diseases in Tetralogy of Fallot has been analyzed in various studies, focusing on the histopathology of the aortic root, altered hemodynamics, and effect of early corrective repair on the incidence of aortic root dilatation. In this review article, we sought to integrate these studies for a better understanding of the natural history and practical implications of aortic root dilatation in Tetralogy of Fallot. This better equips us to appropriately implement potentially effective interventions.

Correction of tetralogy of Fallot in an adult using a stented bioprosthetic valved conduit

A 55-year-old man with tetralogy of Fallot successfully underwent correction using a valved conduit. He was diagnosed as having congenital heart disease during childhood, but no surgical intervention was performed. Cyanosis and dyspnea on effort had progressed gradually. Catheterization showed a left ventricular end diastolic volume of 126 ml, and the pulmonary arteries had sufficient diameters. To prevent postoperative pulmonary regurgitation, we planned to use a bioprosthetic valved conduit for right ventricular outflow tract reconstruction. At 4.5 years after the operation he is in New York Heart Association functional class I. The catheterization performed 1.5 years after the surgery showed no pressure gradient between the right ventricle and the pulmonary artery. Thus, total correction of tetralogy of Fallot in an adult can be achieved safely, and the use of a bioprosthetic stented valved conduit can be beneficial.

Pediatric cardiac surgery in Northern Russia. Results from an international cooperative program

OBJECTIVES

In order to evaluate a Norwegian-Russian clinical cooperation, this study sought to compare the incidence, early mortality and morbidity of surgically treated patients with atrial septum defect (ASD), ventricular septum defect (VSD) and Tetralogy of Fallot (TOF) in Norway and Archangels region in Russia.

DESIGN

A retrospective analysis of patient records of all those surgically treated for ASD, VSD and TOF in Norway and from Archangels region from 1 January 2000 to 31 December 2005.

RESULTS

The Norwegian cohort consisted of 191 ASDs, 227 VSDs and 126 TOFs. The Russian cohort counted 128 ASDs, 77 VSDs and nine TOFs. Thirty-days mortality was 0.4% in the Norwegian VSD, 1.6% in the Norwegian TOF and 1.3% in the Russian VSD cohort. Postoperative complications in the Norwegian cohorts were 18.3% (ASDs), 15.9% (VSDs) and 34.1% (TOFs). The corresponding findings in Archangels were 4.7%, 11.7% and 0%.

CONCLUSION

Surgery for ASDs, VSDs and TOFs can be carried out with minimal early mortality in both countries. The discrepancy in early postoperative morbidity illustrates the challenges in comparative studies between different countries, cultures and health care systems. The establishment of a decentralized surgical facility has increased the access to cardiac surgery to the population in Archangels region.