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Nevertheless, clinical decisions in the long-term follow-up of patients with repaired tetralogy of Fallot (rTOF) are currently based on unisex thresholds for cardiac magnetic resonance (CMR) measurements. This study aimed to assess whether sex differences exist in cardiac adaptation to hemodynamic loading conditions in patients with rTOF. <jats:italic>Methods and Results<\/jats:italic>\u00a0This cross-sectional, two-center, combined pediatric and adult cohort included 320 rTOF patients (163 males, 51%) who underwent routine CMR. Despite similar age (median and interquartile range [m\u2009+\u2009IQR] 23.4 [15.2\u201334.4] years), surgical history, and hemodynamic loading, males with rTOF demonstrated higher biventricular CMR-derived volumes and masses, indexed for body surface area, compared to females (e.g. m\u2009+\u2009IQR right ventricular (RV) end-diastolic volume: males 123 [100\u2013151]\u00a0mL\/m<jats:sup>2<\/jats:sup>, females 114 [94\u2013131]\u00a0mL\/m<jats:sup>2<\/jats:sup>, P\u2009=\u20090.007). Sex-specific Z-scores of biventricular volumes and masses were similar for males and females. RV volumes and masses correlated with hemodynamic loading, but these relations did not differ between sexes. Biventricular ejection fraction (EF) appeared to be lower in male patients, compared to female patients (e.g. m\u2009+\u2009IQR RVEF: males 48 [43\u201354]%, females 52 [46\u201357]%, P &lt;\u20090.001). <jats:italic>Conclusion<\/jats:italic>\u00a0Indexed ventricular volumes and masses are higher in males with rTOF, compared to females, similar to the healthy population. RV hypertrophy and dilatation correlated to loading conditions similarly for both sexes. However, under comparable loading conditions, males demonstrated more severe functional impairment. These results indicate that sex-differences should no longer be ignored in treatment strategies, including timing of pulmonary valve replacement.<\/jats:p>","DOI":"10.1007\/s10554-020-01900-x","type":"journal-article","created":{"date-parts":[[2020,5,30]],"date-time":"2020-05-30T00:03:05Z","timestamp":1590796985000},"page":"1997-2005","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Sex differences in patients with repaired tetralogy of Fallot support a tailored approach for males and females: a cardiac magnetic resonance study"],"prefix":"10.1007","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4208-1449","authenticated-orcid":false,"given":"Quint A. J.","family":"Hagdorn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niek E. 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Berger outside the content of this manuscript. The other authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}