Old Question of the Week

1. A 40-year-old woman with a medical history of surgically corrected tetralogy of Fallot presents with shortness of breath and atrial fibrillation. Which of the following would you expect to be MOST responsible for her symptoms?

Aortic valve regurgitation
Mitral valve regurgitation
Pulmonary valve regurgitation
Tricuspid valve regurgitation

Complete surgical repair for tetralogy of Fallot (TOF) is usually completed in infancy or very early childhood and includes ventricular septal defect closure or patching, resection of infundibular pulmonary stenosis, and placement of a transannular patch or placement of a right ventricle to pulmonary artery conduit (for patients with very small right ventricular outflow tract).  Late complications after repair for TOF include problems with the right ventricular outflow tract, usually pulmonary insufficiency or regurgitation.  Pulmonary stenosis can also occur.  Additionally atrial arrhythmias are common after TOF repair as a chronically volume- and pressure-loaded right ventricle dilates and eventually develops right ventricular failure.


Mark D Twite, Richard J Ing
Tetralogy of Fallot: perioperative anesthetic management of children and adults.
Semin Cardiothorac Vasc Anesth: 2012, 16(2);97-105

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