Current outcomes and treatment of tetralogy of Fallot

摘要

One of the most common types of cyanotic congenital heart disease is Tetralogy of Fallot(ToF).Treatment has constantly increased since the first surgical repair in 1954.Excellent treatment having long-term survival(30 years survival ranges from 68.5%to 90.5%)is available for the ToF.However conventional and frequently required re-interventions include residual issues like right ventricular outflow tract obstruction,pulmonary regurgitation and(ventricular)arrhythmia.Right ventricular dysfunction might lead to longstanding pulmonary regurgitation and/or stenosis.It is important to perform pulmonary valve replacement or relief of pulmonary stenosis prior to irreversible right ventricular dysfunction,though determining optimal timing of pulmonary valve replacement is a problematic task due to various reasons.As seen in longstanding pulmonary regurgitation,the biological mechanisms underlying dysfunction of the right ventricle is often unclear.Various techniques of assessing the right ventricle are used to predict imminent dysfunction.The interventricular,ventriculo-arterial and atrioventricular interactions of right ventricle are not completely explained but play significant role in right ventricle performance.This review focuses on providing a brief overview of the history of ToF,describing the current strategies for treatment and describing the long-term survival,residual lesions and re-interventions following repair.Remaining related challenges and present condition of the art regarding these challenges are also illustrated.