Background: Impaired right ventricular (RV) mechanics is a common problem in patients after repair of tetralogy of Fallot (TOF). Moreover, impaired left ventricular (LV) systolic function has also been demonstrated in this population. There are no studies evaluating patients after TOF repair with impaired both RV and LV ejection fractions (RVEF, LVEF).

Aim: We hypothesised that a considerable group of patients with repaired TOF would demonstrate both RV and LV systolic function impairment. Accordingly, the purpose of our study was to characterise patients with biventricular dysfunction after TOF repair.

Methods: Consecutive patients with repaired TOF undergoing cardiac magnetic resonance (n = 146, mean age 26.4 ± 8.2 years, age range 13.6–51.3 years, 60.3% males, 54 patients [37.0%] with early correction and 92 [63.0%] with late correction).

Results: There were 31 patients (21.2% of the study population; 90.3% males) with biventricular dysfunction. Normal both RVEF and LVEF were observed in 65 (44.5%) individuals. Neither the presence nor the extent of late gadolinium enhancement differed between patients with normal both RVEF and LVEF vs. low both RVEF and LVEF. There were no differences inpulmonary regurgitation (PR) fraction, peak RV outflow tract (RVOT) gradient, and the incidences of significant PR and RVOT obstruction between these groups (p = NS for all comparisons). Multivariate logistic regression revealed that male sex and RVOT aneurysm/akinesia (only in patients repaired early) were associated with the presence of biventricular dysfunction.

Conclusions: In patients with repaired TOF, male sex and RVOT aneurysm/akinesia were independently associated with biventricular dysfunction. Impaired both RVEF and LVEF were common in patients with repaired TOF, with the vast majority being males.