Patient handout

Repaired Tetralogy of Fallot (adult, chronic ACHD)

PRODUCTION

1. Your condition

This handout is for repaired tetralogy of fallot (adult, chronic achd). Your care team identified this based on: pulmonary regurgitation murmur / rv dilatation on imaging.

Other reasons your team may use this plan: reduced exercise tolerance / dyspnea in rtof adult; qrs duration ≥180 ms (scd risk marker); atrial flutter/iart or vt / palpitations.

3. When to call your provider

Contact your care team if any of the following happen:

RV dysfunction approaching irreversibility → expedite PVR — 2018 AHA/ACC ACHD
Sustained VT / aborted SCD → EP + ICD — 2018 AHA/ACC ACHD
Decompensated RV failure → ACHD heart-failure / transplant — 2020 ESC ACHD

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Symptomatic severe PR OR asymptomatic severe PR + ≥2 RV/arrhythmia/QRS criteria — PVR indicated before irreversible RV dysfunction — 2018 AHA/ACC ACHD
QRS ≥180 ms + RV dysfunction, or prior sustained VT/aborted SCD — EP study + ICD consideration — 2018 AHA/ACC ACHD(life-threatening)
Intra-atrial reentrant tachycardia / atrial flutter — ablation + anticoagulation; concomitant cryoablation at PVR — 2020 ESC ACHD
Pregnancy in rTOF — mWHO II–III by RV/PR/arrhythmia; severe PR + RV dysfunction higher risk; pre-pregnancy PVR consideration; cardio-obstetric — 2018 AHA/ACC ACHD; ESC 2018 Pregnancy
End-stage RV/biventricular failure despite PVR/therapy — ACHD advanced-HF / transplant evaluation — 2020 ESC ACHD(life-threatening)

5. Follow-up

Lifelong ACHD follow-up; pregnancy + transition planning; endocarditis education

6. Sources

Guideline: 2018 AHA/ACC Adult Congenital Heart Disease Guideline (Stout) + 2020 ESC Adult Congenital Heart Disease Guideline (Baumgartner)