Tetralogy of Fallot | Acta Medica Marisiensis

Blood biomarkers predicting adverse clinical
outcomes in congenital heart disease patients, with consideration for pulmonary valve replacement

Milla Marika Kainlauri¹, Irina-Bianca Kosovski²

1. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2023-0009

Objective: This review aims to make a brief overview of blood biomarkers’ clinical decision limits, possibly aiding in outcome prediction in all-aged Tetralogy of Fallot patients. Potentially, these biomarkers could also assist in necessity and timing of pulmonary valve replacement. Methods: Studies with all-aged patients with Tetralogy or Pentalogy of Fallot and blood biomarkers, BNP, NT-proBNP and hs-cTn, usage in clinical outcome prediction were included. Additionally, pulmonary valve replacement indications were considered. Other congenital heart diseases, biomarkers irrelevant to clinical outcome and associated pathologies or physiological status were the exclusion criteria. Keywords, Tetralogy and Pentalogy of Fallot, pulmonary valve replacement, blood biomarkers, yielded 69 suitable studies from Google Scholar, PubMed and Web-of-Science. 30 studies were selected. Results: Blood biomarkers were increased in TOF patients in comparison to controls; the higher the values, the worse adverse outcomes. Blood biomarkers combined with other biomarkers, imagistic methods or parameters showed promising results in outcome prediction. Conclusions: Blood biomarkers are validated as follow-up predictors in congenital heart disease paediatric patients. Further research is required to establish age-appropriate clinical decision limits. Pulmonary valve replacement timing remains controversial.

Follow-up in the Surgical Treatment of Tetralogy of Fallot

Căpîlna R¹, Harpa M², Suciu H³, Căpîlna Brîndușa⁴, Brînzaniuc Klara⁵

1 Clinic of Cardiovascular Surgery, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureş, Romania
3 Clinic of Cardiovascular Surgery, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
4 Clinic of Pediatrics I, University of Medicine and Pharmacy, Tîrgu Mureş, Romania
5 Department of Anatomy and Embriology, University of Medicine and Pharmacy, Tîrgu Mureş, Romania

Objective: The purpose of this study is to evaluate the early and intermediate results after total correction of Tetralogy of Fallot in 193 consecutive patients, with a mean age of 29 months, who underwent surgical correction in Transplant and Cardiovascular Disease Institute Târgu Mureș between 2005 and 2011.
Methods: The records of these patients were reviewed. Follow-up was obtained through clinical appointments and telephone questionnaires.
Results: One-hundred forty-four (74%) patients underwent single-stage complete repairs; 49 (25%) patients underwent initial palliative operations (systemic-pulmonary shunt), whereas 40 (20%) of them underwent secondary total corrections. Early and late mortality was 2% (n=4) and 2.5% (n=5), respectively. Mean follow-up was 35 months (range: 4 months to 71 months). Respiratory infection was a risk factor for early mortality (p=0.0032). For the reconstruction of the right ventricular outflow tract we used 21 valved conduits, 68 transannular patches and for the others patients right ventricular patches + pulmonary valvuloplasty/valvulotomy. On late postoperative echocardiography, 59 patients presented moderate pulmonary regurgitation, 21 a small residual ventricular septal defect, 4 severe residual dynamic stenosis of RVOT and 5 calcifications of the transannular patch, for whom we carried out 7 replacements of the pulmonary valve and 14 reconstructions of the right ventricular outflow tract.
Conclusions: Surgical repair of patients with simple or complex forms of tetralogy of Fallot can be achieved with low early mortality. Late mortality and the need for reoperation continue to influence the quality of life for these patients.