Management of Adults with Operated Tetralogy of Fallot.

All patients should have periodic review at an adult congenital heart center. A minimum of history taking, physical examination, electrocardiogram, and echocardiogram are required per visit. Further assessment of right ventricular size and function, preferably by cardiovascular magnetic resonance imaging, is advisable because it provides robust data on biventricular size and function. Exercise testing is a useful objective marker of functional capacity. Interval change in these parameters provides reliable guidance on the need for and the optimal timing of reintervention. These investigations should be considered as a baseline assessment for all patients and can be repeated with variable frequency depending on the severity of residual hemodynamic lesions. Treatment is based on an overall goal of preservation of biventricular function and risk modification for arrhythmia and sudden cardiac death.