If a transannular patch was not performed initially, it should be considered. While some RVOT obstruction can be well-tolerated early on, it is associated with development of ventricular dysrhythmias. The right ventricle in TOF is small and often poorly compliant . Postoperatively, the cumulative effects of bypass, ventricular incision, pulmonary regurgitation , and perhaps a residual VSD or RVOT obstruction will result in low cardiac output with elevated central venous pressure. Pleural effusions may develop.
Treatment consists of inotropic support and diuretics.
Particularly in infants, opening an atrial communication may be beneficial.