Repaired Tetralogy of Fallot

Abstract

Along with surgical and pharmacological innovation, operative mortality of tetralogy of Fallot (TOF) repair has been improved dramatically. The more patients with TOF repair reach their adulthood, the more problems have been revealed particularly in the twenty-first century. To grasp the current overview after TOF repair, recent understanding about TOF is briefly described in section “Introduction.” Pulmonary valve regurgitation and pulmonary valve replacement in patients with repaired TOF is explained in section “Pulmonary Regurgitation and Its Assessment.” More attentions, in the recent era, are paid to the unfavorable effects of pulmonary valve regurgitation which theoretically causes right ventricular volume overload. Considering the deleterious effects of pulmonary valve regurgitation on the right ventricle, timing and indication of pulmonary valve replacement for repaired TOF has been a major concern during this decade and is described in section “Indication and Timing of Pulmonary Valve Replacement” (PVR). Selection of the prosthetic valve for pulmonary valve replacement is another concern, and our surgical policy regarding prosthesis selection is discussed in section “PVR and Selection of Prosthesis.” Surgical technique of pulmonary valve replacement including each procedure is illustrated in detail in section “Surgical Technique.” In the final section, “Tricuspid Regurgitation After TOF Repair,” we proposed our surgical concept of doing simultaneous tricuspid annuloplasty at the time of pulmonary valve replacement in patients with repaired TOF.