Main Article Content
subject of debate, however, in general repair before 3 years of age has resulted in good myocardial performance. Late repair has led to prolonged QRS duration, ventricular dysfunction in terms of myocardial performance index (MPI) and tricuspid annular plane systolic excursion (TAPSE), as well as longer intensive care unit (ICU) stays.
Objective To evaluate QRS duration, right ventricular function as measured by TAPSE, and ICU length of stay (LoS) after repair of TOF performed after three years of age.
Methods This retrospective cohort study was performed in children and adults who underwent ToF repair, with a minimum follow-up of 6 months. The TAPSE and QRS duration were evaluated during follow-up and compared between children who had the operation before vs. 3 years of age or older using Mann Whitney U and Chi-square tests.
Results We enrolled 52 subjects who underwent ToF repair from January 2007 to June 2013 (18 in the ≤3 years-old group and 34 in the >3 years-old group). Subjects’ age at the time of repair ranged from 7 months to 25 years, with follow-up data at 24-30 months after discharge. Abnormalities of the right ventricle and left ventricle MPI were not significantly different between the two groups. However, we observed significant differences between the ≤3 years and >3 years groups in median ICU LoS [2 (range 1-9) days vs. 1.5 (range 1-46) days, respectively; (P=0.016)] and median QRS durations [118 (range 78-140) ms vs. 136 (range 80-190) ms, respectively; (P=0.039)]. The age at the time of repair did not increase the risk of having abnormal TAPSE (RR 0.85; 95%CI 0.26 to 2.79; P=0.798).
Conclusion Tetralogy of Fallot repair after 3 years of age appears to not increase ICU LoS or is associated with lower TAPSE, but it is associated with longer QRS duration. [Paediatr Indones. 2016;56:176-83.].
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
2. Haddad F, Couture P, Tousignant C, Denault AY. The right ventricle in cardiac surgery, a perioperative perspective: II. Pathophysiology, clinical importance and management. Anesth Analg. 2009;108:422-33.
3. Koca B, Oztunc F, Eroglu AG, Gokalo S, Dursun M, Yilmaz R. Evaluation of right ventricular function in patients with tetralogy of Fallot using the myocardial performance index and isovolumic acceleration: a comparison with cardiac magnetic resonance imaging. Cardiol Young. 2014;24:422-9.
4. Koestenberger M, Nagel B, Avian A, Ravekes W, Sorantin E, Cvirn G, et al. Systolic right ventricular function in children and young adults with pulmonary artery hypertension secondary to congenital heart disease and tetralogy of Fallot: tricuspid annular plane systolic excursion (TAPSE) and magnetic resonance imaging data. Congenit Heart Dis. 2012;7:250-8.
5. Lopez L CS, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the pediatric measurements writing group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr. 2010;23:465-95.
6. Brown DW MD, Araoz PA, Zahn EM, Vincent JA, Cheatham JP, et al. Reliability and accuracy of echocardiographic right heart evaluation in the U.S melody valve investigational trial. J Am Soc Echocardiography. 2012;25:383-92.
7. Garson A, Gillete PC, McNamara DG. Propranolol: the preferred palliation for tetralogy of Fallot. Am J Cardiol. 1981;47:1098-104.
8. Park MK. Pediatric cardiology for practitioners. 5th ed. Philadelphia: Mosby Elsevier; 2008. p. 184-91.
9. Mahle WT, Chanani N, Wolf M. Early extubation following infant heart surgery. Proceedings of 62nd Annual Scientific Session & Expo; March 10, 2013. JACC; 2013.
10. Osinaike BB, Akiyemi O, Sanusi AA. ICU utilization by cardio-thoracic patients in a Nigerian teaching hospital: any role for HDU?. Niger J Surg. 2012;18:75-9.
11. Egbe AC, Uppu SC, Mittnacht AJC, Joashi U, Ho D, Nguyen K, et al. Primary tetralogy of Fallot repair: predictors of intensive care morbidity. Asian Cardiovasc Thorac Ann. 2014;22:794-9.
12. Karamlou T, Silber I, Lao R, McCrindle BW, Harris L, Downar E, et al. Outcomes after late reoperation in patients with repaired tetralogy of Fallot: the impact of arrhythmia and arrhythmia surgery. Ann Thorac Surg. 2006;81:1786-93.
13. Wall K, Oddsson H, Ternestedt BM, Jonzon A, Nylander E, Schollin J. Thirty-year electrocardiographic follow-up after repair of tetralogy of Fallot or atrial septal defect. J Electrocardiol. 2007;40:214-7.
14. Planche C, Binet J. Complete repair of tetralogy of Fallot: evolution of operative techniques and results over a 30-year period in 1,398 consecutive patients. In: Redington AN BW, Deanfield JE, Anderson RH, editors. The right heart in congenital heart disease. London: Ashford Colour Press; 1998. pp. 67-74.
15. Alaa-Basiouni M. Primary repair of tetralogy of Fallot in the first year of life: impact of transannular patch on operative mortality and morbidity. J Egypt Soc Cardiothorac Surg. 2005;13:69-77.
16. Sohn S, Lee YT. Outcome of adults with repaired tetralogy of Fallot. J Korean Med Sci. 2000;15:37-43.
17. Naja I, Najm H. The use of transanular patch in TOF: 10 years single centre experience & outcome. J Saudi Heart Assoc. 2012;24:275.
18. Valente AM, Cook S, Festa P, Ko HH, Krishnamurthy R, Taylor AM, et al. Multimodality imaging guidelines for patients with repaired tetralogy of Fallot: a report from the American Society of Echocardiography. J Am Soc Echocardiogr. 2014;27:111-41.
19. Amorim S Cruz C, Macedo F, Bastos PT, Goncalves FR. Tetralogia de Fallot: factores de prognostico apos cirurgia de correccao. Rev Port Cardiol. 2005;24:845-55.
20. Mertens LL, Friedberg MK. Imaging the right ventricle-current state of the art. Nat Rev Cardiol. 2010;7:551-63.
21. Saylan B, Cevik A, Tavli V. Relationship between ventricular function assessed by tissue Doppler imaging and exercise capacity in patients after repair of tetralogy of Fallot: an observational study. Anadolu Kardiyol Derg. 2012;12:490-7.
22. Frogoudaki AA, Daviouros P, Wei L, Kilner PJ, Swan L, Pennel DJ, et al. Right ventricular Doppler myocardial performance index in adults with repaired tetralogy of FAllot: correlations with ventricular volume indices assessed by cardiac magnetic resonance. World Congress; March 17, 2002; Georgia.
23. Luijnenburg SE. Outcome late after repair of tetralogy of Fallot [Dissertation]. [Denhag]: Erasmus MC-Pediatrics Cardiology Division; 2013.
24. Cobanoglu A, Schultz JM. Total correction of tetralogy of Fallot in the first year of life: late results. Ann Thorac Surg. 2002;74:133-8.
25. Folino AF, Daliento L. Arrhythmias after tetralogy of Fallot repair. Indian Pacing Electrophysiol J. 2005;5:312-24.
26. Ho KW, Tan RS, Wong KY, Tan TH, Shankar S, Tan JL. Late complications following tetralogy of Fallot repair: the need for long-term follow-up. Ann Acad Med Singapore. 2007;36:947-53.
27. Pietrzak R, Werner B. Electrocardiographic findings in children with different degrees of pulmonary regurgitation following surgical repair of tetralogy of Fallot. Kardiol Pol. 2012;70:38-43.
28. Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and pulmonary valve replacement decision support. J Cardiovasc Magn Reson. 2011;13:1-24.