Phonocardiogram in adult patients with tetralogy of Fallot

Abstract

Background: Right ventricular outflow tract (RVOT) stenosis and pulmonary regurgitation (PR) are important residua and sequelae in adult tetralogy of Fallot (TOF) patients. Auscultation of the heart sound is a useful tool to detect and evaluate these lesions, but there was no previous report regarding heart sound in adult TOF.

Methods: We enrolled consecutive TOF outpatients from January 2013 to October 2013 in our adult congenital heart disease clinic. Phonocardiogram with phono-recording was performed with MES-1000 (Fukuda-Denshi Co., Tokyo, Japan), and compared heart sound with echocardiographic parameters.

Results: A total of 30 TOF patients were enrolled [age, 34.7±12.8 years; 14 males (46.7%)]. In all 30 patients, phonocardiography was clearly recorded. Eighteen patients (60.0%) had the single second heart sound, which was more frequently observed before than after pulmonary valve reoperation (75.0% vs 11.1%). The single second heart sound was also associated with PR. In 18/30 (60%), diastolic murmur was associated with moderate PR (p=0.008). In 14/30 (46.7%), systolic murmur was associated with moderate RVOT stenosis (p=0.012).

Conclusion: Phonocardiogram was a useful tool to detect RVOT lesions. We should listen to heart sound carefully especially focusing on the second heart sound, systolic, and diastolic murmur.

Keywords: Auscultation; Phonocardiogram; Tetralogy of Fallot.