Commentary: More is not always better

Central MessageAdvanced cardiac imaging provides ever-increasing amounts of data on congenital heart disease. Practical application these by surgeons is not always straightforward.See Article page 196. Advanced straightforward. See anatomic and physiologic As with many things in life, more better. To surgeons, are better when they inform our decision making thus improve surgical outcomes. Shen colleagues1Shen W.-C. Chen C.-A. Chang C.-I. Y.-S. Huang S.-C. Wu M.-H. et al.Outflow tract geometries associated adverse outcome indicators repaired tetralogy Fallot.J Thorac Cardiovasc Surg. 2021; 162: 196-205Abstract Full Text PDF Scopus (4) Google Scholar use magnetic resonance patients Fallot (TOF) to associate 4 unique right ventricular outflow (RVOT) morphologies varying levels remodeling. Although prior studies have described the characteristics RVOT following reconstruction, this study adds correlations distinct geometric categories volume QRS duration. Additionally, show that size discrepancy between branch pulmonary arteries worse long-term exercise capacity.1Shen well addressed authors, has limitations. There no consistency time from capacity evaluation. The authors assert because intervals were similar artery (PA) those without, influence PA valid. This does seem adequately address difference over time. Other factors specific geometry could performance testing include residual lesions, left dysfunction, atrioventricular valve regurgitation, noncardiac lung pathologies,2Ginde S. Earing M.G. When blame: managing disease adult disease.Prog Dis. 2018; 61: 314-319Crossref PubMed (5) Scholar,3Rowe S.A. Zahka K.G. Manolio T.A. Horneffer P.J. Kidd L. Lung function regurgitation limit postoperative Am Coll Cardiol. 1991; 17: 461-466Crossref (124) neurocognitive function.4Cohen Neurocognitive impairment its impact adults 287-293Crossref (12) It also notable unable achieve a maximal effort excluded analysis, which seems impose type selection bias. correlation as marker functional status morphology anatomy would be useful if had controlled for confounding included all data, even poor performers. considering applicability study, it important note describe homogeneous population represent entire spectrum TOF. All cohort underwent transventricular repair patch significant insufficiency. However, there variety techniques can employed TOF utilize atrial approach avoid potential deleterious effects ventriculotomy.5Dietl C.A. Cazzaniga M.E. Dubner S.J. Pérez-Baliño N.A. Torres A.R. Favaloro R.G. Life-threatening arrhythmias RV dysfunction after Fallot. Comparison transatrial approaches.Circulation. 1994; 90: II7-II12PubMed Scholar,6Talwar Anand A. Siddarth B. Ramakrishnan Choudhary S.K. Airan Early trans-right versus atrial, Fallot: results prospective randomized study.Ann Pediatr 2019; 12: 3-9Crossref (3) mean age at complete 2.5 years any infant or neonatal repairs, uncommon current era.7Loomba R.S. Buelow M.W. Woods R.K. Complete non-neonatal period: meta-analysis.Pediatr 2017; 38: 893-901Crossref (26) Scholar,8Bailey J. Elci O.U. Mascio C.E. Mercer-Rosa Goldmuntz E. Staged symptomatic neonate Fallot.Ann 2020; 109: 802-808Abstract (13) In their conclusion, endorse proactive stenosis less-extensive incision/patching beneficial preservation mechanics, without practical association defined. novel additive literature. article composed, findings prove helpful device development percutaneous intervention RVOT. That said, remains seen how we Outflow FallotThe Journal Thoracic Cardiovascular SurgeryVol. 162Issue 1PreviewA wide been reported (rTOF). We aimed investigate associations RVOT/PA large rTOF receiving non-conduit repair. Full-Text