Perioperative management of tetralogy of Fallot repair

Understanding the morphological and haemodynamic changes associated with surgical correction of tetralogy of Fallot is vital in planning a rational basis for the postoperative management. The past five years have seen a fall in mortality figures from more than 10% to 2% and the reasons for this improvement are reviewed. There have been changes in the preoperative assessment and therapy, but perhaps the most significant change has been in operative technique. The correction now is performed by a transatrial approach, whereas in the past a large ventriculotomy was used. There has been a change in emphasis in the various postoperative manoeuvres employed. Early low-dosage inotrope support, cavity drainage, intravenous hyperalimentation, peritoneal dialysis, sequential pacing and ventilation until cardio-respiratory stability is achieved, form the basis of our postoperative regime.