Timing of pulmonary valve replacement in tetralogy of fallot using cardiac magnetic resonance imaging: an evolving process.

The observation that adults with repaired tetralogy of Fallot (TOF) outnumber children is a testament to the exponential improvements in the medical and surgical management of the disease (1). The first Black-Taussig shunt placement in 1945 (2,3), improved life expectancy from a few months to years. Lillehei et al. (4) followed with the first open heart repair in 1954. The current early survival of TOF is excellent, pproximating 90% through the first 2 decades of life. In the hird decade, however, mortality rate increases (5,6) with residual sequelae truncating long-term life expectancy and affecting quality of life (7). Risk factors that predict adverse outcome are: (1) older age of repair; (2) evidence of sustained ventricular tachycardia or longer QRS duration; (3) and hemodynamic compromise due to long-term pulmonary regurgitation with right ventricular (RV) dilation and dysfunction of both right and left ventricles (1, 8 –11).