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Pediatric Cardiology

, Volume 40, Issue 8, pp 1722–1727 | Cite as

The Limited Benefit of Follow-Up Echocardiograms After Repair of Tetralogy of Fallot

  • Jack Xu
  • Caleb Guthrey
  • Stephen Dalby
  • Xinyu Tang
  • Joshua Daily
  • R. Thomas CollinsEmail author
Original Article
  • 115 Downloads

Abstract

Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease, making up 10% of all congenital heart defects. Annual follow-up echocardiograms are recommended in patients with repaired ToF, but evidence-based guidelines do not exist. We hypothesized that most echocardiograms performed in asymptomatic patients with repaired ToF and no physical exam change do not result in an actionable change (AC) in management. We retrospectively reviewed records of all patients with ToF and prior complete repair at our institution between January 2000 and September 2015. Changes in echocardiograms resulting in hospital admission, medication addition/change, cardiac catheterization, or surgical procedure were identified via chart review. These changes were referred to as an AC. A total of 1135 echocardiograms were reviewed from 233 patients (160 with initial complete repair, 70 with prior shunt, and 3 with other initial surgery). The median number of echocardiograms per patient was 5. Of the 1135 echocardiograms, 15 (1.3%) were associated with AC. Of the 15 patients with AC echocardiograms, 9 underwent a shunt prior to complete repair (9/70, 12.9%) and 6 had undergone an initial complete repair (6/160, 3.8%). The median age at AC was 6.3 years (IQR 4.4, 6.8) in the shunt group and 0.90 years (IQR 0.87, 1.1) in the initial complete repair group. In asymptomatic patients with repaired ToF and no physical exam change, echocardiograms rarely lead to a change in clinical management. In conclusion, the likelihood and timing of AC echocardiograms and reinterventions vary based on the type of initial surgery.

Keywords

Tetralogy of Fallot Echocardiograms Follow-up Outcomes 

Notes

Compliance with Ethical Standards

Conflict of interest

None of the authors has any relation with industry that could influence the impartiality of this study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Arkansas for Medical SciencesLittle RockUSA
  2. 2.Department of Internal MedicineUniversity of Arkansas for Medical SciencesLittle RockUSA
  3. 3.Arkansas Children’s Hospital, University of Arkansas for Medical SciencesLittle RockUSA
  4. 4.Rutgers Robert Wood Johnson Medical SchoolNew BrunswickUSA
  5. 5.Stanford University School of MedicinePalo AltoUSA
  6. 6.Lucile Packard Children’s Hospital StanfordPalo AltoUSA

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