Total correction of tetralogy of Fallot in adults

A series of 42 patients who underwent total correction of tetralogy of Fallot as adults is presented. Previous palliative operation had been performed in 33 cases: Blalock-Taussig shunt in 28 (bilateral in 6), Brock operation in four and Potts' anastomosis in one case. Severe cyanosis (average hemoglobin 203 g/l), thrombotic complications and hypoxic spells were the most pertinent of the clinical manifestations necessitating the total repair. Blalock-Taussig shunt had closed spontaneously before the intracardiac operation in 14 cases (3 bilateral) and in 11 it was ligated. In six cases the shunt was left untreated, being hemodynamically insignificant at operation. Three of the 42 patients died in association with the intracardiac operation. A-V block developed in two patients and required permanent pacemaker. During follow-up periods of up to 13 years, a residual ventricular septal defect was found in seven patients. Two of the defects were surgically closed. Five were not corrected, as the patients were doing well and the pulmonary/systemic flow ratio was less than 1.5 at repeat catheterization. Two-thirds of the patients were in NYHA class I at re-examination, and the others were in class II. The subjective functional improvement was greater than could have been expected from results of exercise tolerance tests.