Restrictive Right Ventricular Physiology in Children After Tetralogy of Fallot Repair: Mechanisms and Multiorgan Interactions

ABSTRACT Restrictive right ventricular physiology (RRVP) occurs due to impaired right ventricular compliance and associated diastolic dysfunction. This results in reduced cardiac output and elevated central venous pressure with downstream consequences for the liver, kidneys, gut, and lymphatic system. RRVP is frequently seen after surgical repair of tetralogy of Fallot (TOF), though it occurs across a range of congenital heart defects with long‐standing RV pressure overload. This review provides a clinically oriented description of the pathophysiology, patients at risk, end‐organ consequences, and management of RRVP in the immediate post‐operative period after TOF repair.