Surgically repaired tetralogy of Fallot in the 7th decade: a late presentation of severe pulmonic regurgitation.
Adult congenital heart disease
Guidelines
Heart failure
Pulmonic regurgitation
Seventh decade
Surgical repair
Tetralogy of Fallot
Journal
The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology
ISSN: 2090-911X
Titre abrégé: Egypt Heart J
Pays: Germany
ID NLM: 9106952
Informations de publication
Date de publication:
14 Apr 2024
14 Apr 2024
Historique:
received:
17
01
2024
accepted:
07
04
2024
medline:
14
4
2024
pubmed:
14
4
2024
entrez:
14
4
2024
Statut:
epublish
Résumé
Surgically repaired tetralogy of Fallot (TOF) is a congenital heart disease with a cumulative survival rate of 72% in the 4th decade of life in longitudinal single-cohort studies. Debate surrounds conservative versus surgical management in adults with TOF once pulmonary regurgitation occurs. A 73-year-old male with surgically corrected TOF presented with heart failure symptoms. He underwent ToF repair with a classic right Blalock-Taussig shunt at 2 years of age with transannular patching at 18 years of age. Echocardiography revealed elevated right ventricular systolic pressures, severe right ventricular dilatation, and pulmonary regurgitation. Our patient's new-onset right-sided heart failure was managed medically with diuresis. He received a new pulmonic valve via percutaneous approach on a later planned hospitalization with resolution of symptoms and improved tricuspid regurgitation. It is a class I recommendation for pulmonic valve intervention once greater than moderate PR occurs; however, medical optimization should take place first. Following adequate RV load optimization, our patient underwent successful transcatheter pulmonic valve implantation with resolution of symptoms and cessation of diuretic.
Sections du résumé
BACKGROUND
BACKGROUND
Surgically repaired tetralogy of Fallot (TOF) is a congenital heart disease with a cumulative survival rate of 72% in the 4th decade of life in longitudinal single-cohort studies. Debate surrounds conservative versus surgical management in adults with TOF once pulmonary regurgitation occurs.
CASE PRESENTATION
METHODS
A 73-year-old male with surgically corrected TOF presented with heart failure symptoms. He underwent ToF repair with a classic right Blalock-Taussig shunt at 2 years of age with transannular patching at 18 years of age. Echocardiography revealed elevated right ventricular systolic pressures, severe right ventricular dilatation, and pulmonary regurgitation. Our patient's new-onset right-sided heart failure was managed medically with diuresis. He received a new pulmonic valve via percutaneous approach on a later planned hospitalization with resolution of symptoms and improved tricuspid regurgitation.
CONCLUSION
CONCLUSIONS
It is a class I recommendation for pulmonic valve intervention once greater than moderate PR occurs; however, medical optimization should take place first. Following adequate RV load optimization, our patient underwent successful transcatheter pulmonic valve implantation with resolution of symptoms and cessation of diuretic.
Identifiants
pubmed: 38615306
doi: 10.1186/s43044-024-00477-3
pii: 10.1186/s43044-024-00477-3
doi:
Types de publication
Journal Article
Langues
eng
Pagination
46Informations de copyright
© 2024. The Author(s).
Références
Lillehei CW, Varco RL, Cohen M et al (1986) The first open heart corrections of tetralogy of Fallot: a 26-to-31-year follow-up of 106 patients. Ann Surg 204:490–502
doi: 10.1097/00000658-198610000-00017
pubmed: 3767482
pmcid: 1251326
Bichell DP (2014) Fourth decade after repair of tetralogy of Fallot: taking aim at moving targets. Circulation 130(22):1931–1932. https://doi.org/10.1161/CIRCULATIONAHA.114.013270
doi: 10.1161/CIRCULATIONAHA.114.013270
pubmed: 25341441
Cuypers JA, Menting ME, Konings EE, Opić P, Utens EM, Helbing WA, Witsenburg M, van den Bosch AE, Ouhlous M, van Domburg RT, Rizopoulos D, Meijboom FJ, Boersma E, Bogers AJ, Roos-Hesselink JW (2014) Unnatural history of tetralogy of Fallot: prospective follow-up of 40 years after surgical correction. Circulation 130(22):1944–1953. https://doi.org/10.1161/CIRCULATIONAHA.114.009454
doi: 10.1161/CIRCULATIONAHA.114.009454
pubmed: 25341442
Davlouros PA, Kilner PJ, Hornung TS, Li W, Francis JM, Moon JC, Smith GC, Tat T, Pennell DJ, Gatzoulis MA (2002) Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol 40(11):2044–2052. https://doi.org/10.1016/s0735-1097(02)02566-4
doi: 10.1016/s0735-1097(02)02566-4
pubmed: 12475468
Warner KG, O’Brien PKH, Rhodes J et al (2003) Expanding the indications for pulmonary valve replacement after repair of tetralogy of Fallot. Ann Thorac Surg 76:1066–1072
doi: 10.1016/S0003-4975(03)00748-3
pubmed: 14529986
Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ (2004) Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol 43(6):1068–1074. https://doi.org/10.1016/j.jacc.2003.10.045
doi: 10.1016/j.jacc.2003.10.045
pubmed: 15028368
Oechslin EN, Harrison DA, Harris L et al (1999) Reoperation in adults with repair of tetralogy of Fallot: indications and outcomes. J Thorac Cardiovasc Surg 118:245–251
doi: 10.1016/S0022-5223(99)70214-X
pubmed: 10424997
Gatzoulis MA, Balaji S, Webber SA et al (2000) Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet 356:975–981
doi: 10.1016/S0140-6736(00)02714-8
pubmed: 11041398
Yemets IM, Williams WG, Webb GD et al (1997) Pulmonary valve replacement late after repair of tetralogy of Fallot. Ann Thorac Surg 64:526–530
doi: 10.1016/S0003-4975(97)00577-8
pubmed: 9262606
Nørgaard MA, Lauridsen P, Helvind M, Pettersson G (1999) Twenty-to-thirty-seven-year follow-up after repair for Tetralogy of Fallot. Eur J Cardio-Thoracic Surg 16(2):125–130. https://doi.org/10.1016/S1010-7940(99)00137-2
doi: 10.1016/S1010-7940(99)00137-2
Dennis M, Moore B, Kotchetkova I, Pressley L, Cordina R, Celermajer DS (2017) Adults with repaired tetralogy: low mortality but high morbidity up to middle age. Open Heart 4(1):e000564. https://doi.org/10.1136/openhrt-2016-000564
doi: 10.1136/openhrt-2016-000564
pubmed: 28698799
pmcid: 5495176
Nollert G, Fischlein T, Bouterwek S, Böhmer C, Klinner W, Reichart B (1997) Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair. J Am Coll Cardiol 30(5):1374–1383. https://doi.org/10.1016/s0735-1097(97)00318-5
doi: 10.1016/s0735-1097(97)00318-5
pubmed: 9350942
Stout KK, Daniels CJ, Aboulhosn JA et al (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 139:e698-800
pubmed: 30586767