Primary Total Correction of Tetralogy of Fallot in Children Less Than Four Years of Age

Abstract

Twenty-two consecutive severely symptomatic infants and small children less than 4 years of age (mean age 25.5 months, range 3½ to 48 months) have presented for initial surgical treatment of the tetralogy of Fallot at the University of Alabama Medical Center between September 1, 1971 and January 31, 1973. One was considered unsuitable for complete repair because of massive thrombosis of the inferior vena cava, and was successfully treated by a right Blalock-Taus-sig operation. Twenty-one were treated by primary intracardiac repair. One patient (age 24 months) died, a hospital mortality rate of 4.8%. Mean value for the RV/LV peak pressure ratio immediately after repair was 0.55. An outflow patch was placed across the valve ring in one patient, and should have been placed in one other. Heart block has not occurred. Profound hypothermia and circulatory arrest (Kyoto-Barratt-Boyes technique) was used in 9 patients, and cardiopulmonary bypass with profound hypothermia in 12. We discuss the controversy concerning initial management of infants and small children severely symptomatic from the tetralogy of Fallot, and conclude that primary intracardiac repair is advisable in centers prepared for infant intracardiac surgery.