Results of Repair of Tetralogy of Fallot

Abstract

One hundred and forty-six patients had radical operations for tetralogy of Fallot. In the early phase vertical ventriculotomy was used, often with extensive reconstruction of the outflow tract. In the late phase, transverse ventriculotomy was introduced and fewer outflow tract patches were inserted. The overall mortality (operative and late) was 10% to 13% in the first phase and 7% in the second phase. Ninety-one patients were investigated by cardiac catheterization 1 year after surgery; 21 were virtually cured, four had residual outflow tract gradients of more than 50 mm Hg, and 12 had severe pulmonary incompetence. Six had a residual ventricular septal defect, and three had associated lesions. Pulmonary incompetence occurred in three patients who had infundibular resection only; otherwise it was associated with pulmonary valvulotomy and was more severe if an outflow tract patch was carried across the pulmonary valve ring. Seven patients were recatheterized 5 years after the first postoperative study. The hemodynamics did not alter. Right ventricular angiocardiography in 32 patients showed that half the patients after infundibular resection only showed a noncontractile portion of the outflow tract, and patients with a patch had an inert anterior wall of the right ventricle. A patch carried across the valve ring reestablished an inert but adequate conduit.