DOES RESTRICTIVE RIGHT-VENTRICULAR PHYSIOLOGY IN THE EARLY POSTOPERATIVE PERIOD PREDICT SUBSEQUENT RIGHT-VENTRICULAR RESTRICTION AFTER REPAIR OF TETRALOGY OF FALLOT

Objective-To assess the relation between immediate postoperative right ventricular (RV) diastolic physiology and subsequent diastolic functi on in patients after repair of tetralogy of Fallot. Design-Serial pros pective echocardiographic study early after surgical repair of tetralo gy of Fallot and at mid-term follow up. Setting-Tertiary referral cent re. Patients-34 patients who had repair of tetralogy of Fallot between 1992 and 1995 were studied. Main outcome measures-Restrictive RV phys iology defined as antegrade how in the pulmonary artery in late diasto le throughout the respiratory cycle. Results-Sixteen of the 34 patient s had early restrictive RV physiology. The need for transannular patch repair was an independent variable predictive of early restriction (o dds ratio 4.3 p < 0.05). Nine of 16 patients with early restriction al so had restriction at follow up, while 15 of 16 patients without restr ictive 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). Conclusions-Early and mid-term restri ctive RV physiology after repair of tetralogy of Fallot is related to the repair type. Although evidence for this physiology tends to resolv e in the first few days after operation, it is highly predictive of su bsequent abnormalities of RV diastolic function. Similarly, normal RV diastolic physiology without restriction in the immediate postoperativ e period persists in the mid-term and may be associated with the long term problems of progressive RV dilatation.