Usos de objetos

As quality of life and behavioural/emotional functioning showed the same results in the ToF70 and ToF80 patients, no clear improvements over time could be observed. Compared to the normal population ToF patients scored lower on general health and vitality.(27) This could indicate patients are aware of the disease in daily life. On the other hand they scored higher on social sub domains, thereby indicating they did not feel to be emotionally with-held because of this disease. This is in line with previous studies, for instance by Hickey et al.

who showed SF-36 scores were significantly below normal for physical domains in 840 adults ToF patients(5) This appreciation of social functioning was confirmed by the results of the Adult Self-Report, in which we found less anxiety or internalizing problems and aggressive or externalizing problems.(18) The lower prevalence of behaviour problems may be due to the fact that these patients show a “response shift””. A respons shift is described in patients who have survived surgical correction and often had multiple hospital admissions. To cope with this major life event they have consequently developed a better coping mechanism. This may lead to a better subjective quality of life.(28)

study limitations

In 2001 MRI was not performed routinely and also the modern echocardiographic measure-ments, such as speckle tracking and 3D, were not available yet. Since we could not compare these techniques, we did not include these techniques in this study. The echocardiographic left ventricular end systolic diameter may not be valid in all patients, considering the para-doxal septal deviation, therefore LV end systolic diameter and fractional shortening should be seen in this light. Exercise testing was done without maximum VO2, which would have been optimal. This study is an observational non-randomised trial; therefore conclusions should be drawn with care.

concLusion

In 2001 we studied patients with ToF operated between 1968-1980, in the current study we repeated the protocol 10 years later in patients operated between 1980-1990. This study demonstrats that with an earlier stage surgery, there is a trend towards a diminished early mortality rate and late survival remained good. Although the left ventricle seems to be better protected by surgery at younger age. By avoiding the extensive use of a transannular patch, the need for reoperations may further decrease. Overall, quality of life was good with no significant differences between the two cohorts.

Evolution of Tetralogy of Fallot surgery 51

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Chapter 4

Long-term psychosocial outcome of adults with