CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 4, July/August 2011
AFRICA
181
months of age. Furthermore, post surgery, hypotony of the lower
limbs was present in one patient who had a longer hospital stay
to enable the lower limbs to recover their function. These factors
accounted for the longer length of hospital stay in our series.
During follow up, no deaths were registered. All patients were
in NYHA class I. Similar data were reported by Bisoi
et al
.,
11
who stated that total correction of ToF in teenagers and adults
offers the best option for long-term, symptom-free survival.
No malignant rhythm disturbances were recorded on ECG.
Right ventricular hypertrophy with a right bundle branch block
(RBBB) recorded on ECG persisted after surgery. Bouzas
12
showed that the presence of RBBB in post-TOF repair is
extremely common and may mask the presence of RV hyper-
trophy. Progressive lengthening of the QRS duration with time
reflects RV enlargement and potential RV failure.
We observed a drop, although not statistically significant,
in the RVOT pressure from the acute post-surgical period. No
difference in RVOT pressure was registered between the patients
with annuloplasty and infundibuloplasty. No restrictive Doppler
pattern was observed in assessing the right ventricle, contrary to
the study of Cardoso and Miyague,
13
who reported that restric-
tive right ventricular physiology was present in most patients
undergoing repair of ToF with a trans-annular patch. This may
be a transient phenomenon of incomplete adaptation of the right
ventricle to volume and pressure modifications.
Over six years of follow up, right ventricular function
was mildly depressed in 5% of cases, and mild to moderate
pulmonary regurgitation was evident in 13.7%. Pulmonary
regurgitation (PR) is related to the use of a trans-annular patch
during RVOT reconstruction and aggressive infundibulectomy
involving the pulmonary valve annulus. Although PR is report-
edly well tolerated in several clinical studies, long-term follow
up has shown that this can lead to considerable disability. The
adverse effects of PR include progressive dilatation of the RV,
reduced exercise capacity, arrhythmia and sudden death. The
right ventricular function and pulmonary valve of these patients
will need close monitoring to anticipate pulmonary or tricuspid
valve replacement.
Our study had two limitations. First, we had a limited number
of patients enrolled. Second, longer follow up is needed.
Conclusion
The study showed good early results in the post-surgical follow
up of older patients with ToF. The right ventricular function and
pulmonary valve will need close surveillance, and timely and
appropriate interventions must be taken to optimise outcomes.
We thank Associazione Bambini Cardiopatici nel Mondo, Cuore Fratello and
the Tertiary Sisters of St Francis for their collaboration in saving the lives of
Cameroonian children.
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