Andrade AC, Jerosch-Herold M, Wegner P, et al. - Researchers sought to assess the prevalence and determinants of impaired left-sided cardiac function among asymptomatic patients with repaired tetralogy of Fallot. In addition, they examined these patients for adverse ventricular remodeling and the relation of left ventricular (LV) dysfunction and remodeling with cardiopulmonary exercise capacity. In this cross-sectional study, they assessed 103 patients with tetralogy of Fallot (median age, 16.3 years) in New York Heart Association class 1, with surgical repair at a median age of 1.1 years, and 63 age-matched controls. Patients with tetralogy of Fallot had lower LV ejection fraction, lower LV mass index, lower LV mass/volume ratio, and impaired left atrial function. For LV systolic dysfunction and for a lower LV mass/volume ratio, the best predictor was right ventricular mass/volume ratio. They observed higher LV extracellular volume, particularly in female patients, which was associated with subnormal peak oxygen consumption, compared with controls. A peak oxygen consumption below the third percentile reference level was more frequent with declining LV ejection fraction, and lower LV mass index, but independent of right ventricular ejection fraction. These findings suggest LV cardiomyopathic changes in young to middle-aged patients with tetralogy of Fallot at a median of 14 years after repair.