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Objectives: Although the current surgical approach of tetralogy of Fallot (TOF) is primary complete repair in infancy, late diagnosis and lack of surgical facilities in developing countries may delay surgical treatment. Some of these patients exposed to prolonged chronic hypoxaemia are transferred to more privileged countries to undergo surgical repair with the support of non-governmental organizations. The objective of this single-centre retrospective study was to compare the postoperative outcomes of these foreign patients undergoing delayed repair with those of patients born in France undergoing timely repair during the same time period., Methods: The computer database of our institution was searched for all cases of TOF in foreign patients younger than 15 years, supported by two non-profit organizations, who underwent complete repair between January 2007 and December 2013. The control population consisted of the patients with TOF born in France, who underwent timely complete repair during the same period., Results: The 47 foreign children were older (57.6 ± 38.4 vs 8.3 ± 9.1 months, P < 0.0001), more hypoxaemic (SaO2 79 ± 11 vs 91 ± 8%, P < 0.0001), more growth-retarded (body mass index Z-score -1.35 ± 1.5 vs -0.46 ± 1.3, P = 0.0034), and had higher haematocrit level (52.5 ± 11.7 vs 37.5 ± 6.1%, <0.0001) and worse left ventricular ejection fraction (LVEF 62 ± 8 vs 69 ± 3.8%, P < 0.0001) than the 90 French patients. Postoperative mortality and morbidity (sepsis, arrhythmia, bleeding and need for surgical revision) were similar in the two groups, except for a higher rate of pericardial and/or pleural effusion in foreign children (36 vs 17%, P = 0.02). Length of stay was shorter in foreign than in French patients (11 ± 6 vs 15 ± 15 days, P = 0.0012)., Conclusions: In our experience, despite the presence of several risk factors (growth retardation, chronic hypoxaemia, polycythaemia and left ventricular dysfunction), late repair of TOF was undertaken during childhood in patients from developing countries with no difference in postoperative morbidity and mortality compared with that of timely repair during infancy. These older patients can be discharged sooner. However, patients undergoing late surgery may be at higher risk of complications of right ventricular failure, such as pleural and/or pericardial effusion., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Objective: To assesses the results of our education program relative to anticoagulation therapy and self-monitoring of INR., Materials and Methods: All children treated with oral anticoagulation therapy and followed using INR self-monitoring in Tours and Nantes, France, were included. A questionnaire on the treatment and its management was sent to the patients and their family. We analyzed the quality of anticoagulation using the proportion of INR within the target range., Results: Thirty-three children were included, with a mean age of 10.9years. Thirty-one questionnaires could be analyzed. Insufficient knowledge on the treatment objective and risks, the INR target range, and the interpretation of the INR was observed. We found 65.8% of INRs within the target range. The proportion of INRs within the target range was better with the INR self-testing than with the laboratory test (69.7% vs. 49.1%, P=0.003). There was no major complication observed during the study period. A moderate correlation (K=0.57) was noted between the INRs measured with the point-of-care monitor and the laboratory test on the same day., Conclusion: However, home-monitoring of oral anticoagulation therapy increases the quality of anticoagulation. Both education and the training program need improvement in order to provide patients and their families with better knowledge on anticoagulation therapy., (Copyright © 2013. Published by Elsevier SAS.)