Suggested follow-up cardiac testing after surgical repair of tetralogy of Fallot

Test	Suggested schedule
Echocardiography	During childhood: At least once annually In adulthood: Every 6 months to 2 years, depending on physiologic stage
ECG	At least once annually in children and adults
CMR or cardiac CT^*	During childhood: Not typically performed unless there is specific clinical concern for RV dilation and/or RV dysfunction In adolescence and adulthood: Every 1 to 3 years depending on physiologic stage
Ambulatory ECG monitoring	During childhood: Can be considered every 3 to 4 years or more frequently if there are symptoms or other clinical concerns for arrhythmia In adolescence and adulthood: Every 1 to 2 years for individuals with physiologic stage C or D
Exercise testing	During childhood: Not typically performed In adolescence and adulthood: Every 1 to 5 years depending on level of clinical concern
Cardiac catheterization	Not routinely performed (indications include evaluation prior to transcatheter intervention or evaluation for suspected pulmonary hypertension)
Electrophysiologic study with ventricular stimulation	Not routinely performed (indications include documented VT or multiple risk factors for VT)

This table summarizes our general approach to follow-up cardiac testing in individuals who have undergone surgical repair of TOF. Testing should be tailored to the individual, and the frequency of testing may vary depending on the patient's age, type of repair, degree of symptoms, and active cardiovascular conditions (such as arrhythmias, RV dilation, RVOT obstruction, pulmonary vascular disease, left heart failure). Refer to UpToDate topics on management of TOF for additional details.

CMR: cardiovascular magnetic resonance; CT: computed tomography; ECG: electrocardiography; RV: right ventricle; RVOT: right ventricular outflow tract; TOF: tetralogy of Fallot; VT: ventricular tachycardia.

* Cardiac CT may be used if CMR is not feasible. When using cardiac CT, the benefit of routine imaging must be weighed against the risks associated with radiation exposure.

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Suggested follow-up cardiac testing after surgical repair of tetralogy of Fallot