Residual anatomic, hemodynamic and functional abnormalities after Tetralogy of Fallot repair

Objective: Most patients are left with residual abnormalities after post-surgical repair of Tetralogy of Fallot. The aim of this study is to assess anatomic, hemodynamic and functional outcomes after surgical repair of this congenital heart disease, long-term follow-up and factors that influence these results. Methods: It was performed a systematic literature review through “Preferred Reporting Items for Systematic review and Meta-Analysis Protocols” (PRISMA-P) checklist. The following databases were included: PubMed, Virtual Health Library, Cochrane Library, and Scientific Electronic Library Online of studies published from 2018 to 2022. Results: The transannular patch and homograft/conduit implant techniques expose patients to chronic pulmonary regurgitation, while valve-sparing procedures may cause residual pulmonary stenosis. After surgical repair, most patients remain with residual lesions, such as right ventricular dilatation from chronic pulmonary regurgitation, pulmonary artery stenosis, right ventricular outflow tract aneurysm, tricuspid regurgitation, ventricular septal defects and dilation of aorta. Dysfunction of the right ventricle may appear and, subsequently, the left, arrhythmias, right ventricular strain, pulmonary edema, heart failure, and sudden death. Anatomical and functional cardiac alterations may arise, like obstruction of the right ventricular outflow tract, pulmonary artery branch stenosis, and pulmonary valve regurgitation. Conclusion: Residual lesions after repair lead to significant morbidity in adult patient's lives. The knowledge of outcomes provides opportunities to assess treatment decisions and guide surgical strategies. It is essential to evaluate the adverse clinical events to improve the quality of life of these patients and reduce morbidity and mortality.