Common Inquiries
Examples of Common Inquiries We Receive from Patients
The answer depends on the specific condition. During an actual consultation, I will provide an answer after reviewing your test results and medical history.
I've been told since I was a child that I have an aortic condition. Is it okay to be upfront about it when I apply for a job?
CT scans and other imaging tests are essential for evaluating congenital aortic disorders. I believe that if you undergo the necessary tests and have the test results and treatment history documented in a medical certificate, you’ll feel more at ease about returning to work.
When I was a child, I was told I had a hole in my heart, but I haven’t been to the doctor even once since becoming an adult. Should I get checked out now?
Even in cases of ventricular septal defects or atrial septal defects that were placed under observation during childhood, heart valve disease, arrhythmias, or pulmonary hypertension may be diagnosed in adulthood. Even if you have no symptoms, we recommend having an echocardiogram or similar test to assess your current condition.
I've had the Fontan procedure. What should I be careful about going forward?
After Fontan surgery, arrhythmias, swelling, and liver problems may develop as you age. We recommend that you undergo regular evaluations at a specialized outpatient clinic for adult congenital heart disease, where both your heart and liver are assessed.
I'm thinking about getting pregnant. Is it okay if I tell my OB/GYN that I've had heart surgery?
Because pregnancy and childbirth place a significant strain on the heart, we recommend that you be evaluated by both a cardiologist and an obstetrician before becoming pregnant. Depending on the condition of your heart, treatment may be considered before pregnancy.
My doctor has been telling me to “wait and see” all along, but I'm worried—is it really okay to just keep things as they are?
While observation is often the appropriate course of action, it is important to monitor changes in the heart’s size and function—for example, through cardiac MRI—to ensure you do not miss the optimal timing for reoperation. Based on your current test results, I will provide my professional opinion.
It’s been several decades since I had surgery for Tetralogy of Fallot, and lately I’ve been getting tired more easily. Is it because of my age?
If pulmonary regurgitation persists and causes the right ventricle to enlarge, this may manifest as fatigue or shortness of breath. Since the condition of the right ventricle cannot be determined based on symptoms alone, we recommend evaluating it with a cardiac MRI and an exercise stress test.
Since becoming an adult, I've started getting short of breath when climbing stairs. Do I need another surgery?
Shortness of breath is one of the factors that may lead to consideration of reoperation. Since the decision is based on a comprehensive assessment of the severity of pulmonary valve regurgitation, right ventricular volume, and the presence or absence of arrhythmias, please have your most recent test results on hand when you come in for your consultation.
During an exercise stress test, I was told that my exercise tolerance had decreased.
A decrease in exercise tolerance is one of the findings considered when determining the timing of reoperation. It is evaluated in conjunction with the size and function of the right ventricle, as measured by cardiac MRI.
I’ve been told I have severe pulmonary regurgitation, but I don’t have any symptoms. Is it okay to just keep an eye on it for now?
Even if you have no symptoms, right ventricular enlargement may be progressing. We recommend having your right ventricular volume measured regularly via cardiac MRI to monitor for any changes.
I was told that my right ventricle is enlarged. How big does it have to get before I need surgery?
We use the right ventricular volume measured by cardiac MRI—adjusted for body size—as a guideline, but we make our assessment based on a combination of symptoms, arrhythmias, and QRS width. We recommend that you undergo an evaluation at a specialized facility before right ventricular enlargement progresses.
I was told that my QRS complex was prolonged on the ECG.
A prolonged QRS complex is associated with right ventricular enlargement and is considered one of the indicators of an increased risk of ventricular arrhythmias. Please consult with us regarding the results of your right ventricular assessment from the cardiac MRI and your Holter ECG.
I have heart palpitations, and I was told I have an irregular heartbeat. Is this related to Tetralogy of Fallot?
After surgery for Tetralogy of Fallot, the incidence of arrhythmias originating in the atria or ventricles increases in adulthood. Along with treating the arrhythmias, treatment for the underlying causes—such as pulmonary regurgitation and right ventricular enlargement—may also be considered.
I've been advised to have another surgery, but I don't know which hospital to go to.
Reoperative surgery for complex congenital heart defects is among the most challenging procedures in cardiac surgery, and we recommend that you undergo it at a facility with experience in treating congenital heart defects in adults. We are available to discuss this with you, including matters such as the convenience of follow-up visits and coordination with your primary care physician.
Quick Tip!: Reoperation Following Correction of Tetralogy of Fallot
Problems Common in Adulthood Following Corrective Surgery for Tetralogy of Fallot
In corrective surgery for Tetralogy of Fallot, the function of the pulmonary valve is often compromised in order to widen the narrow right ventricular outflow tract, and pulmonary regurgitation often persists for a long time after surgery. If pulmonary regurgitation continues, the right ventricle gradually enlarges, and right ventricular function may deteriorate without the patient experiencing any noticeable symptoms. In adulthood, the following problems are likely to occur:- Pulmonary regurgitation and right ventricular enlargement caused by pulmonary regurgitation
- Decreased exercise tolerance (the ability to perform physical activity), such as fatigue and shortness of breath
- Widening of the QRS complex on an electrocardiogram
- Arrhythmias originating in the atria or ventricles
- Stenosis of the right ventricular outflow tract or pulmonary artery, and enlargement of the aorta
How Are the Indications and Timing for Pulmonary Valve Replacement (Revision Surgery) Determined?
The decision to perform reoperation is based not only on the presence or absence of symptoms but also on a comprehensive assessment of right ventricular volume and function as measured by cardiac MRI, the degree of pulmonary valve regurgitation, QRS width, the presence or absence of arrhythmias, and exercise tolerance.If surgery is performed after the right ventricle has become significantly enlarged, the right ventricle’s size and function may not fully recover after the procedure. On the other hand, since artificial valves have a limited lifespan, performing surgery too early may increase the number of future reoperations. The timing of reoperation must be determined on an individual basis, taking into account the progression of test results over time.
Measuring Right Ventricular Volume and Pulmonary Valve Regurgitation Using Cardiac MRI
The right ventricle has a complex shape, and it is sometimes impossible to accurately measure its size using echocardiography alone. After surgery for Tetralogy of Fallot, cardiac MRI is used to measure the right ventricle’s end-diastolic volume, end-systolic volume, and ejection fraction, as well as the pulmonary regurgitation rate, to assess changes since the previous examination and determine the appropriate timing for reoperation.Dr. Itatani is also conducting research using 4D Flow MRI to visualize blood flow within the heart in three dimensions and evaluate the workload on the right ventricle.
Seeking a Second Opinion from a Surgeon Specializing in Congenital Heart Disease in Adults
Reoperative surgery for adult patients with Tetralogy of Fallot often involves a second or subsequent open-chest procedure, and there are only a limited number of facilities capable of managing adhesions and complex anatomy. Please use our online consultation service if you fall into any of the following categories:- Those who have been told by their current healthcare provider to undergo follow-up observation but are concerned they may be missing the optimal timing for reoperation
- Those who have been advised to undergo reoperation but are unsure which hospital to choose
- Those seeking a second opinion regarding their treatment plan
- Attending physicians seeking referral options for adult patients with Tetralogy of Fallot