Korigirana Fallotova tetralogija u odrasloj dobi – prikaz slučaja i kratki pregled literature

Bolesnici s korigiranom Fallotovom tetralogijom (ToF), zbog razvoja mogućih komplikacija upravo u odrasloj dobi, trebaju se redovito kontrolirati u tercijarnom centru za prirođene bolesti srca (PBS) u odraslih. U slučaju stabilnog tijeka bolesti kontrole su najčešće indicirane u jednogodišnjem intervalu. Važno je, osim detaljne anamneze o eventualnoj pojavi simptoma, uvijek tražiti potencijalne komplikacije. Ako je riječ o značajnoj pulmonalnoj regurgitaciji (PR), što je najčešća kasna komplikaci- ja korigirane ToF, potrebno ju je kvanti cirati te pratiti promjenu u veličini i funkciji desne klijetke (DK). Važno je u donošenju odluke o reoperaciji na pulmonalnoj valvuli (PV) ne čekati predugo radi očuvanja funkcije DK, ali i imati u vidu bržu progresiju disfunkcije proteze ako se ugradi u mlađoj dobi. Budući da su ovakvi bolesnici u jednoj od najrizičnijih skupina unutar populacije odraslih s prirođenim bole- stima srca za pojavu iznenadne srčane smrti, potrebno je njihov rizik strati cirati za sada dostupnim metodama i razmotriti postoji li indikacija za implantaciju kardioverter-defibrilatora. Osim navedenih, potrebno je pri svakoj kontroli tragati i za svim ostalim mogućim komplikacijama radi što boljeg i sveobuhvatnijeg praćenja i liječenja ovih bolesnika.
Patients with repaired tetralogy of Fallot (ToF), due to the development of complications in adulthood, need to attend regular follow-up at a tertiary adult congenital heart disease (ACHD) center. If disease progression is stable, the follow-up visits are most often indicated on a yearly basis. In addi- tion to a detailed history of symptoms development, it is important to always look for possible compli- cations. In case of a signi cant pulmonary regurgitation (PR), which is the most frequent late compli- cation of repaired ToF, it needs to be quanti ed, and changes in right ventricular (RV) size and function need to be monitored. It is important not to postpone the re-intervention on the pulmonary valve (PV) for too long in order to preserve the RV function. It is also important to bear in mind the possible faster progression of prosthesis dysfunction if the operation was done at an earlier age. Since repaired ToF patients belong to the group of ACHD conditions with the highest risk of sudden cardiac death (SCD), it is necessary to stratify their risk by using currently available methods and to consider whether there are any indications for the implantation of a cardioverter de brillator. In addition to the above, during each follow-up it is necessary to search for all other possible complications in order to better and more comprehensively monitor and treat these patients.