Invited commentary

Abstract

The article by Sadiq and colleagues [1Sadiq A. Shyamkrishnan K.G. Theodore S. Sreeram G. Tharakan J.M. Karunakaran J. Long-term functional assessment after correction of tetralogy of Fallot in adulthood.Ann Thorac Surg. 2007; 83: 1790-1796Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar] presents the topic of correction of tetralogy of Fallot in the grown-up population. The reported hospital mortality of 7%, and the causes of early death-bleeding complications in 3 patients, and multiorgan failure in 1 patient are in line with current literature. After the operation, 10 patients were reoperated on for bleeding complications, and prolonged inotropic support for right ventricular failure was necessary in 6 patients. These data affirm previous reported potential risk factors for early mortality, which are the sequelae of prolonged cyanosis, eg, myocardial fibrosis, impaired renal and hepatic function, and coagulation anomalies. Balancing the competing problems of residual right ventricular outflow tract obstruction and pulmonary insufficiency is of major concern in adults undergoing correction of tetralogy of Fallot. Although pulmonary insufficiency seems to be well tolerated in children, most authors report deleterious effects of pulmonary insufficiency during the postoperative period after correction of tetralogy of Fallot in adulthood. Sadiq and colleagues [1Sadiq A. Shyamkrishnan K.G. Theodore S. Sreeram G. Tharakan J.M. Karunakaran J. Long-term functional assessment after correction of tetralogy of Fallot in adulthood.Ann Thorac Surg. 2007; 83: 1790-1796Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar] used an intraoperative cut-point of 0.8 for the right to left ventricular pressure ratio for revising the right ventricular outflow tract. This ratio appears somewhat high, even though, it may prevent severe pulmonary insufficiency. At final follow-up, only 1 patient had severe pulmonary insufficiency, but the authors did not report the degree of pulmonary insufficiency immediately after the operation or its relationship to early mortality and morbidity. Several studies justify high operative mortality because functional status and quality of life are improved in survivors after surgical correction. However, in these studies functional status was subjectively assessed primarily according to the New York Heart Association functional class. For the first time, Sadiq and colleagues [1Sadiq A. Shyamkrishnan K.G. Theodore S. Sreeram G. Tharakan J.M. Karunakaran J. Long-term functional assessment after correction of tetralogy of Fallot in adulthood.Ann Thorac Surg. 2007; 83: 1790-1796Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar] provide objective data on exercise tolerance by performing treadmill testing in 36 patients. Accordingly, 35 patients showed good effort tolerance, and none had a positive result of exercise-induced arrhythmia, angina, or significant blood pressure changes. Nevertheless, whether or not total repair improves survival in adult patients is debatable. Because most of these patients are selected (ie, favorable morphology), the natural history of this disease can not be compared with the natural history reported for the general population of patients who have tetralogy of Fallot. Long-Term Functional Assessment After Correction of Tetralogy of Fallot in AdulthoodThe Annals of Thoracic SurgeryVol. 83Issue 5PreviewTetralogy of Fallot presenting in adulthood is a surgical challenge. We present the long-term outcomes of surgical correction in this subset of patients, including results of postoperative effort tolerance as assessed by treadmill testing. Full-Text PDF