Residual problems with repaired tetralogy of fallot.

Operable Problems Pulmonary regurgitation and RVOT stenosis are anatomical complications that can be relieved only by anatomical repair including surgery and percutaneous catheter treatment.4,5 Therefore, appropriate timing of such intervention is important. However, definite criteria for reoperation are not yet determined. There were several advocated criteria for re-intervention using magnetic resonance imaging (MRI).6,7 We routinely decide the timing of reoperation according to the following parameters: RV and LV end-diastolic volume index; etralogy of Fallot (TOF) includes 4 major anatomical features: right ventricular outflow tract (RVOT) obstruction (hypoplasia); ventricular septal defect; deviation of the origin of the aorta to the right ventricle; and concentric right ventriclular (RV) hypertrophy. TOF is the most common cyanotic congenital heart disease, accounting for 10% of congenital heart disease.1 Despite improved mortality rates of TOF patients, thanks to recent progress in comprehensive management, including intracardiac repair, there are postoperative late complications.2,3 Prevention and management of these are of paramount importance. Sudden death in adulthood is commonly from either ventricular arrhythmia or heart failure. There are operable and non-operable residua and sequelae in adult TOF patients long-term after repair (Figure). It is recognized that patients with RV dilatation and dysfunction with or without severe tricuspid regurgitation have T