Successful permanent resynchronization for failing right ventricle after repair of tetralogy of Fallot.

Abstract

After repair of tetralogy of Fallot with significantly decreased exercise tolerance, a 17-year-old symptomatic boy underwent successful permanent resynchronization of a failing right ventricle (RV). The patient had surgical repair including pulmonary valvulotomy, infundibulectomy, and pericardial right ventricular outflow tract (RVOT) plasty at 1 year of age. At 3 years of age, he underwent resection of RVOT aneurysm, pulmonary valvuloplasty, and patch enlargement of the left pulmonary artery. Finally, a balloon pulmonary valvuloplasty of a mild residual pulmonary valve stenosis was performed at 17 years of age, resulting in a gradient reduction from 18 to 4 mm Hg and mild (grade I) pulmonary and tricuspid regurgitation. However, the patient continued to show significant RV dilation and systolic/diastolic dysfunction with signs of major RV dyssynchrony (right bundle-branch block; QRS duration of 200 ms and paradoxical interventricular septal …