Modern-era pediatric tetralogy of Fallot cohort shows functional changes by adolescence

A commentary in *Pediatric Research* discusses a retrospective study of 95 children who underwent repair of tetralogy of Fallot or tetralogy-type double-outlet right ventricle at one referral hospital between 2000 and 2015. Patients had serial cardiac assessments, including echocardiography, electrocardiography, Holter monitoring, exercise testing and cardiac magnetic resonance imaging. Median follow-up was 15.7 years.

No deaths were reported. After repair, three patients had ectopic atrial tachycardia, four had non-sustained ventricular tachycardia and one had atrioventricular block; nine underwent pulmonary valve replacement. Exercise capacity declined significantly from ages 8 to 18, although peak workload increased. Compared with non-valve-sparing repair, valve-sparing repair was associated with lower pulmonary insufficiency and right ventricular volumes, while ejection fractions and peak aerobic capacity were comparable.

The commentators note that the contemporary cohort and multimodal follow-up offer insight into pediatric outcomes, but the single-center design and small sample limit generalizability and statistical power. The study did not assess later adult outcomes such as sudden cardiac death. Measures including ejection fraction and peak oxygen uptake are used as risk predictors but have not been validated individually as clinical endpoints; the findings do not establish that earlier or more intensive surveillance improves outcomes.