Repair of tetralogy of Fallot in infancy: Early and late results

Abstract

In 41 consecutive infants, ranging in age from 12 days to 1 year (mean age 5.7 months), tetralogy of Fallot (TOF) was repaired with the aid of deep hypothermic circulatory arrest. One infant had absence of the pulmonary valve; two had congenital absence of the left pulmonary artery; and one had an aorticopulmonary window. Thirty-eight required a right ventricular outflow patch; in 29 the patch extended across the pulmonary valve annulus. All had patch closure of the ventricular septal defect (VSD); in one infant a perforated patch was used because of severe hypoplasia of both pulmonary arteries. The hospital mortality rate was 7 percent (three patients). There were no late deaths. Transient complete heart block occurred in one patient and right bundle branch block with left anterior hemiblock persisted for 1 year after operation in three patients. Cardiac output (determined by the Fick or thermodilution method) and intracavitary pressures were measured after operation in 22 patients. So far, 19 patients have had catheterization studies 1 year after operation. Aneurysms of the right ventricle developed in two instances. Both infants, treated early in the series, had residual right ventricular outflow gradients of more than 50 mm. Hg. Both of these patients, and another infant with a residual VSD (Q p /Q s > 2:1), have been successfully reoperated upon. We conclude that the hospital mortality rate and the early and late results justify our continued evaluation of primary repair of TOF in symptomatic infants, regardless of weight or age. Our present contraindications to reparative surgery in symptomatic infants with TOF are an anterior descending coronary artery arising from the right coronary artery or associated congenital pulmonary atresia (discontinuity of the right ventricle and pulmonary artery).