Fourteen- to Nineteen-Year Follow-Up After Corrective Repair for Tetralogy of Fallot

A long-term follow-up was made of the first 28 patients who survived corrective repair for tetralogy of Fallot at the Department of Thoracic Surgery R, Rigshospitalet. Copenhagen. They were discharged in the years 1960–1964. There were 20 males and 8 females. The age at operation was 6–41 years (median 12 years). Nineteen patients had previous palliative operations. All of them had one or more postoperative clinical examinations at the hospital and 18 had postoperative heart catheterizations. Six patients had died, five within 10 years after operation (21.4%: 95% confidence limits 8.3–41.0%). Four late deaths were clearly related to residual cardiovascular abnormalities, insufficient VSD closure being the main problem. One further death was due to a malignant arrhythmia provoked at the routine postoperative heart catheterization. Two deaths were sudden, one in a patient with a ruptured VSD. The only patient with transient a-v block postoperatively, who later died, did so from pump failure after the second operation; none had had left anterior hemiblock and in none were extrasystoles demonstrated. The 22 survivors were asked to answer a questionnaire regarding their occupation, physical activity, participation in sports, pregnancies and medication. All answered and thus none were lost to follow-up. The follow-up time was 14–19 years (mean 16.7 years) and the age at follow-up was 23–57 years (mean 30.2). Five patients had a residual VSD and 3 had a significant systolic pressure gradient of more than 30 mmHg across the outflow tract of the right ventricle. Twelve patients had pulmonary valve incompetence. Only one patient had had endocarditis and was left with slight aortic valve incompetence. Twenty patients were considered to be in NYHA functional class I and the remaining two in class II. Two of 7 females had undergone uncomplicated pregnancies. Eight patients were or had been engaged in sports. Seventeen patients were working full-time without limitation, one was in an institution for mentally retarded and working part-time, one was temporarily unemployed and one did not state her occupation but was probably a housewife. The two oldest patients received disablement pensions. Only two patients received digitalis. Notwithstanding residual abnormalities, nearly all the survivors follow a normal pattern of life, with no symptoms and only slight or no limitation in their daily activities. Their educational and occupational status seems to be equivalent to that of the general population.