Course of right and left ventricular function in patients with pulmonary insufficiency after repair of tetralogy of Fallot

Surgical repair of tetralogy of Fallot (TOF) frequently results in pulmonar y valve insufficiency. Nevertheless, no serial information is available on the longterm impact of the valvular insufficiency on right and left ventric ular function. Right and left ventricular ejection fraction was measured se rially by radionuclide angiocardiography in 21 patients with at least moder ate pulmonary insufficiency after repair of TOF. A baseline study was obtai ned an average of 1.2 years after repair, and a follow-up study was perform ed an average of 10.2 years after surgery. Changes in ventricular function over time and deviations from the normal range were analyzed. At baseline e valuation the mean right ventricular ejection fraction (RVEF; 0.52 +/- 0.10 ) and left ventricular ejection fraction (LVEF; 0.68 +/- 0.10) were normal. At the time of follow-up the mean RVEF had significantly decreased to 0.45 +/- 0.09 (p < 0.01). The mean LVEF had decreased to 0.60 +/- 0.11 (p < 0.0 2). This change was independent of the RVEF (r = -0.13). Eleven patients (5 2%) had an abnormal RVEF or LVEF at follow-up. Nineteen patients (90%) show ed a decrease of 0.05 or more in RVEF, LVEF, or both between studies. These data suggest a negative impact of long-standing pulmonary insufficiency on right and left ventricular systolic function after repair of TOF. Therefor e, continued surveillance of biventricular function in this patient populat ion appears warranted.