Multiple Reoperations during a 48-Year Postoperative Course of Repaired Tetralogy of Fallot

Hideaki Kanda＊	Shinya Kuramoto＊	Tomoyuki Matsuba＊
Yoshiya Shigehisa＊	Yutaka Imoto＊

（Cardiovascular and Gastrointestinal Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan）

Due to the increasing number of patients with repaired tetralogy of Fallot（TOF), the amount of subsequent sequelae has also increased along with the need for further surgical interventions. This case report described a patient who underwent multiple reoperations for late sequelae over a period of 48 years after repair of TOF. The patient was a 58-year-old man who underwent a reparative operation for TOF at the age of 9 years. At the age of 30, he underwent patch closure of residual VSD and reconstruction of right ventricular outflow tract（RVOT）with a mono-cusped trans-annular patch combined with aortic valve replacement. At the age of 47, he underwent aortic root replacement for aneurysmal dilatation of the Valsalva sinus, and he was implanted with a pacemaker for bradycardia atrial fibrillation at the age of 51. By the age of 58, he required pulmonary valve replacement and tricuspid valve annuloplasty for right ventricular dysfunction resulting from regurgitation of the pulmonary and tricuspid valves as 4th midline sternotomy surgery. His status improved to NYHA functional class III to II after the most recent procedures, although he still needed strict medical control. A proactive approach during long-term follow-up after TOF repair is important for timely and appropriate surgical intervention in the event of late sequelae.

 

Jpn. J. Cardiovasc. Surg. 47:95-99（2018）

Keywords：tetralogy of Fallot;reoperation;pulmonary valve regurgitation;right-sided cardiac failure