Title : Successful surgical repair of fallot tetralogy, is follow up still indicated?
Tetralogy of fallot (TOF) is one of the common congenital cardiac malformations. Advances in surgical management allow long term survival of this group of patients. Medical management after surgical repair is still indicated for selected cases for variable periods of time. Surgical treatment with trans-annular patch is associated with pulmonary regurgitation (PR) which was reported to be tolerated for years. It results in right ventricular (RV) volume overload with potential RV dysfunction, and/or arrhythmias. Arrhythmias and sudden death were reported in this group of patients. RV volume is better assessed by cardiac magnetic resonance imaging (CMRI). RV end diastolic volume index (RVEDVI) is used to evaluate patient for need of pulmonary valve replacement (PVR). PVR would be indicated in selected cases to protect RV from volume overload as well as arrhythmias. In the presence of PR, the presence of clinical symptoms clearly corresponds to class I evidence of indication for PV implantation in both the European and North-American guidelines. General agreement exists on the indication in asymptomatic patients in the presence of any of the following criteria, as judged by echocardiography and/or magnetic resonance imaging: pulmonary valve (PV) regurgitation> 20%. , Indexed end-diastolic right ventricular volume>120–150 ml/m2 and Indexed end-systolic right ventricular volume > 80–90 ml/m2. Infective endocarditis is still a possible complication even after successful repair. Peripheral pulmonary stenosis could develop with subsequent pressure overload effect on the RV with possibility of RV failure, the need for percutaneous balloon dilatation and stent placement is sometimes indicated. Exercise capacity could be affected later in life, whether related to PR severity or not is still unclear