Right Ventricular Dysfunction Post-Surgical Repair of Fallot Tetralogy in Pediatric Age Group: Predictor Factors Analysis

Ihab Mohamed Salah Eldin Elsharkawy; Tarek  Salah; John Malaty Fouad; Mahmoud Abdo Omar Abualfa; Ashraf Mostafa Abd Raboh

Ihab Mohamed Salah Eldin Elsharkawy Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Tarek Salah Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
John Malaty Fouad Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Mahmoud Abdo Omar Abualfa Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
Ashraf Mostafa Abd Raboh Department of Cardiothoracic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt

Keywords: Tetralogy of Fallot, Pediatrics, Intensive Care Units, Right Ventricular Dysfunction

Abstract

Background: Right ventricular (RV) dysfunction is often detected after Tetralogy of Fallot (TOF) repair. We aimed to analyze the preoperative, intraoperative, and postoperative risk factors for RV dysfunction and to correlate them to the surgical technique used in the repair.

Methods: This prospective cohort study included 26 pediatric patients with TOF. The participants were divided into two groups based on RV dysfunction. Group A included patients with RV dysfunction, and Group B included patients without RV dysfunction. Each patient was assessed clinically and via echocardiography and cardiac magnetic resonance. Participants were followed for 6 months.

Results: The incidence of RV dysfunction was 30.8% of patients. Compared to group B, patients in group A had significantly low preoperative oxygen saturation (p=0.011), high Right ventricular outflow tract pressure gradient (RVOT PG) (p=0.03), operative transannular patch (p=0.011), prolonged intubation time (p=0.017), and pediatric intensive care unit stay (p=0.001), high incidence of inadequate urine output (p=0.014), prolonged inotropic use (p=0.02) as well as low postoperative tricuspid annular plane systolic excursion (TAPSE) (p˂0.001) and fractional area change (FAC)(p˂0.001), and high RVOT pressure gradient (p˂0.001). However, regression analysis showed no statistical correlation between these variables and RV dysfunction.

Conclusion: Physicians should consider low preoperative oxygen saturation, high RVOT PG, operative transannular patch, long intubation time and pediatric intensive care unit stay, high incidence of inadequate urine output, prolonged inotropic use as well as low postoperative TAPSE and FAC, and high RVOT pressure gradient as risk factors for RV dysfunction after TOF repair in pediatrics.