Does limited right ventriculotomy prevent right ventricular dilatation and dysfunction in patients who undergo transannular repair of tetralogy of Fallot? Matched comparison of magnetic resonance imaging parameters with conventional right ventriculotomy long-term after repair.

Abstract

The objective of this study was to test the hypothesis that limited (<1 cm) right ventriculotomy (RV-tomy) in the setting of transannular tetralogy of Fallot (TOF) repair might result in less right ventricular (RV) dilatation and dysfunction compared with conventional RV-tomy. Between June 2002 and April 2012, 113 patients with transannular repair of TOF underwent magnetic resonance imaging (MRI). Patients were divided into a limited RV-tomy group (n = 39) and a conventional RV-tomy group (n = 74). Thirty-nine patients from each group were matched for comparison using propensity scores. The MRI parameters of the 2 groups were compared. The interval between TOF repair and MRI examination was shorter in the limited RV-tomy group (limited, 12.7 ± 3.8 years; conventional, 17.2 ± 4.7 years; P < .001). Indexed RV volumes were similar between the groups (RV end-diastolic volume index: 149 ± 31 mL/m(2) vs 152 ± 42 mL/m(2); P = .704. RV end-systolic volume index: 70 ± 24 mL/m(2) vs 77 ± 38 mL/m(2); P = .313). There was no difference in the RV ejection fraction between the groups (54% ± 9% vs 51% ± 9%; P = .160). Propensity score-matched comparison also revealed no differences in RV volume and function. No long-term benefits of limited RV-tomy were demonstrated compared with conventional RV-tomy in patients who underwent transannular TOF repair, at least in terms of RV volume and function. Further studies are necessary to define the role of limited RV-tomy in patients who undergo transannular TOF repair.