Left and right ventricular adaptation to right ventricular overload before and after surgical repair of tetralogy of Fallot.

On the basis of angiographic projections, left (n = 43) and right (n = 56) ventricular volume data were obtained in patients with tetralogy of Fallot before and after surgical repair. The postoperative patients were divided into 3 groups according to the degree of an additional volume load secondary to a residual ventricular septal defect or pulmonary insufficiency, or both. The decreased left ventricular ejection fraction (p less than 0.01) in preoperative tetralogy of Fallot in the presence of a normal sized left ventricle suggests depressed global myocardial function, which is not improved after surgical repair, even if excellent results are achieved. A certain functional reserve, however, seems to be preserved, since the ejection fraction did not decrease further with increasing additional volume loads. Similar enlargement of the right ventricle secondary to comparable degrees of pulmonary insufficiency and residual ventricular septal defect indicates similar effects of additional diastolic and systolic filling on right ventricular function in patients with tetralogy of Fallot after surgical repair. Even in patients with excellent surgical results, such as those without significant right ventricular outflow tract obstruction and additional volume load, right ventricular pump function is depressed, the ejection fraction being significantly (p less than 0.01) lower than normal. The further decrease of global myocardial function with increasing volume load suggests a loss of functional reserve. Attempts to minimize right ventricular volume load after surgical repair seem advisable.