Tetralogy of Fallot: Total Correction

Abstract

he events that give rise to the c1evelol)iiieiit of the T constellation of lesions that we refer to as tetralogj of Fallot are still micertain. Regardless of the true teleological cause, it is hel1)ful for the surgeon to approach this defect as resulting from anterocephalad deviation of the ventricular outlet septum. "monology with sequellae." The resulting malalignment ventricular septal defect (VSD), aortic override, ancl right ventricular outflow tract ol~struction are thus easily understood. The right ventricular hypertrophy can he appreciated as secondary to the VSD and right ventricular outflow tract ohstructioii. Right ventricular outflow obstruction is increased by hypertrophy of the anterior limb of the septal ]land, anomalous anterior muscular bands, and outlet septum as well as pulmonary valve and arterial anomalies (Fig I). Classically the VSD is circular, juxtaaortic, and nonrestrictive and results from the malalignment of the parietal extension of the infundibular and trabecular septae. As such, the defect lies between the infundibular septum and is cradled by the anterior and posterior limbs of the septal band (Fig 11).