Long-term Results of Aortopulmonary Anastomosis for Tetralogy of Fallot

Abstract

A review of 340 patients with tetralogy of Fallot undergoing aortopulmonary anastomosis of the Potts-Smith type (descending aorta to pulmonary artery) has been made for assessment of the complications and long-term results (1946-1969) of this procedure. There were 30 operative deaths (9%) and 52 late medical deaths (20%) The symptomatic improvement has remained impressive in the survivors even up to 20 years after shunt surgery, with 85% of the patients having a functional classification of I or II. The major late complications have been related to anastomotic channels which were made or eventually became too large, resulting in congestive heart failure (20 late medical deaths) or in pulmonary hypertension with pulmonary vascular obstructive disease. These complications are not unique to the Potts operation, and may be anticipated in patients with excessively large ascending aorta to right pulmonary artery anastomoses. Careful patient follow-up is indicated and, in the event of congestive heart failure or evidence for pulmonary hypertension, an aggressive approach with either shunt take down and intracardiac repair or shunt revision should be considered.