Unresolved questions
Questions that remain regarding the management of
tetralogy of Fallot pertain to the preference of surgical timing,
as discussed above, and to the residual lesions of the
disease. The management of young adults with pulmonary
regurgitation or residual pulmonary stenosis is complex.
A balance must be achieved between limiting the
haemodynamic burden on the right ventricle, and minimizing
the life-time number of surgical interventions
required for a given patient. Cardiac magnetic resonance
imaging has progressed significantly in the past ten years
(Figures 9a and 9b). This provides reliable objective data,
in addition to echocardiography and exercise testing, that
physicians can use to determine the optimal timing of
reintervention [41-43]. Recent advances in interventional
cardiac catheterisation now provide safe options for treatment
other than cardiac surgery. Devices such as the percutaneously
placed pulmonary valve have shown
promising results in the management of selected patients
with pulmonary regurgitation and stenosis [44,45].
Ongoing advances in diagnostics and minimally invasive
procedures will continue to help improve the care of these
adult patients with tetralogy of Fallot.