FALLOT'S TETRALOGY--SOME RADIOLOGICAL AND OTHER FINDINGS IN THE FIRST FEW YEARS AFTER TOTAL CORRECTION.

Abstract

Twenty-seven children who survived total correction of Fallot's tetralogy are reviewed and 14 with suspected complications were reinvestigated by cardiac catheterisation and contrast studies. There were three late deaths. Of the remaining 24, 16 are well and have no evidence of complications other than pulmonary incompetence. One child has moderate residual pulmonary stenosis; there has been some reopening of the ventricular septal defect in six, all with a residual right ventricular/pulmonary artery systolic gradient of between 20 and 53 mm Hg (one has since had further surgical repair). One child developed marked pulmonary incompetence. The plain X-ray and angiocardiographic appearances are described. Dilatation of the infundibulum of the right ventricle was an important feature. It varied from a slight convexity to aneurysm formation. It gave a reliable indication of persistently raised right ventricular pressure, indicating persistent outflow obstruction, reopening of the ventricular septal defect, or both. A rapid increase in size was followed by death in one, and by successful re-operation in another child. The appearance of the pulmonary valves on angiocardiography was unreliable in the diagnosis of persistent pulmonary stenosis following operation unless there was distinct doming of the valves. Recatheterisation is the only certain method of detecting significant residual stenosis. Distortion of the appearance of the left ventricular outflow tract in systole appeared to be without functional significance.