When is surgical treatment of tetralogy of Fallot (TOF) performed in adults?

Updated: Nov 13, 2018
  • Author: Shabir Bhimji, MD, PhD; Chief Editor: Yasmine S Ali, MD, FACC, FACP, MSCI  more...
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Although it is no longer in question that adult patients with pulmonary valve insufficiency require surgery, there is still some debate over when the surgery should take place. Previously, surgery was usually recommended based on the presence of whether the QRS interval was longer than 180 milliseconds on electrocardiography (ECG). More recently, some surgeons believe that pulmonary valve replacement is only necessary when there is evidence of RV dysfunction. Others state that it should be performed when the patient is symptomatic. Still others opine that earlier surgery based on echocardiographic findings irrespective of symptoms is appropriate. 

In addition, conflicting arguments exist about whether to undertake surgery early or late. The general consensus is that waiting for symptoms to develop before undertaking surgery may be too late and the RV may then become irreversibly damaged. Nevertheless, regardless of the existing debate, the pulmonary valve should be replaced before heart failure develops. However, if the patient has no symptoms and has only mild RV dilatation and normal RV function, then no surgery is indicated. [27]

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