Heart 1998;79:481-484 ( May )

Does restrictive right ventricular physiology in the early postoperative period predict subsequent right ventricular restriction after repair of tetralogy of Fallot?

G Norgård, M A Gatzoulis, M Josen, S Cullen, A N Redington

Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London

Correspondence to: Professor A N Redington, Department of Paediatrics, Royal Brompton Hospital, Sydney Street, London SW3 6NP.

Accepted for publication 2 February 1998

ObjectiveTo assess the relation between immediate postoperative right ventricular (RV) diastolic physiology and subsequent diastolic function in patients after repair of tetralogy of Fallot.
DesignSerial prospective echocardiographic study early after surgical repair of tetralogy of Fallot and at mid-term follow up.
SettingTertiary referral centre.
Patients34 patients who had repair of tetralogy of Fallot between 1992 and 1995 were studied.
Main outcome measuresRestrictive RV physiology defined as antegrade flow in the pulmonary artery in late diastole throughout the respiratory cycle.
ResultsSixteen of the 34 patients had early restrictive RV physiology. The need for transannular patch repair was an independent variable predictive of early restriction (odds ratio 4.3 (1.1-47), p < 0.05). Nine of 16 patients with early restriction also had restriction at follow up, while 15 of 16 patients without restrictive RV physiology continued without restriction. Early restriction was the only independent variable predictive of late restriction (odds ratio 6.0 (1.9-273), p = 0.01).
ConclusionsEarly and mid-term restrictive RV physiology after repair of tetralogy of Fallot is related to the repair type. Although evidence for this physiology tends to resolve in the first few days after operation, it is highly predictive of subsequent abnormalities of RV diastolic function. Similarly, normal RV diastolic physiology without restriction in the immediate postoperative period persists in the mid-term and may be associated with the long term problems of progressive RV dilatation.

Keywords: restrictive right ventricular physiology;  evolution;  tetralogy of Fallot;  congenital heart disease

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© 1998 by Heart
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