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Response to: Correspondence on “Tetralogy of Fallot: management of residual hemodynamic and electrophysiological abnormalities” by Yalta et al
  1. Ali N Zaidi
  1. Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Ali N Zaidi, Cardiology, Mount Sinai School of Medicine, New York, New York, USA; Ali.Zaidi{at}

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Tetralogy of Fallot (TOF) is a cyanotic congenital heart disorder, where initial surgical management may comprise palliative aortopulmonary shunts and eventual complete intracardiac surgical repair. Although long-term outcomes are excellent, patients have to be monitored for haemodynamic and electrophysiological sequelae including severe pulmonary regurgitation (PR), right ventricular enlargement and/or dysfunction, tricuspid regurgitation (TR) and risk for atrial or ventricular arrhythmias with appropriate risk mitigation for sudden cardiac death (SCD).1 The long-term effects of chronic, severe PR on the right ventricle (RV) in repaired TOF (rTOF) is influenced by ventricular compliance, the degree and duration of PR, and particular characteristics of the pulmonary arteries (such as large vessel capacitance). As the RV’s compensatory mechanisms to handle the volume load (imposed by longstanding PR) fail, the RV progressively dilates. Significant RV dilation may lead to the stretch of the tricuspid annulus leading to poor coaptation of the tricuspid leaflets …

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  • Contributors ANZ is the sole contributor.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.

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