Does restrictive right ventricular physiology in the early postoperative period predict subsequent right ventricular restriction after repair of tetralogy of Fallot?

OBJECTIVE To assess the relation between immediate postoperative right ventricular (RV) diastolic physiology and subsequent diastolic function in patients after repair of tetralogy of Fallot. DESIGN Serial prospective echocardiographic study early after surgical repair of tetralogy of Fallot and at mid-term follow up. SETTING Tertiary referral centre. PATIENTS 34 patients who had repair of tetralogy of Fallot between 1992 and 1995 were studied. MAIN OUTCOME MEASURES Restrictive RV physiology defined as antegrade flow in the pulmonary artery in late diastole throughout the respiratory cycle. RESULTS Sixteen of the 34 patients had early restrictive RV physiology. The need for transannular patch repair was an independent variable predictive of early restriction (odds ratio 4.3 (1.1-47), p < 0.05). Nine of 16 patients with early restriction also had restriction at follow up, while 15 of 16 patients without restrictive RV physiology continued without restriction. Early restriction was the only independent variable predictive of late restriction (odds ratio 6.0 (1.9-273), p = 0.01). CONCLUSIONS Early and mid-term restrictive RV physiology after repair of tetralogy of Fallot is related to the repair type. Although evidence for this physiology tends to resolve in the first few days after operation, it is highly predictive of subsequent abnormalities of RV diastolic function. Similarly, normal RV diastolic physiology without restriction in the immediate postoperative period persists in the mid-term and may be associated with the long term problems of progressive RV dilatation.