The criteria for reconstruction of right ventricular outflow tract in total correction of tetralogy of Fallot

Abstract

Retrospective analysis was undertaken to determine the influence of residual pulmonary stenosis and surgically induced pulmonary insufficiency on the operative mortality rate in 104 patients with tetralogy of Fallot who underwent total correction between 1967 to 1970 at First Department of Surgery, Osaka University Hospital. This study revealed that, in order to improve the operative outcome in this anomaly, it is necessary to correct pulmonary stenosis to the point of the right-to-left ventricular peak pressure ratio (PRV/LV) less than 0.8 as well as preventing severe pulmonary insufficiency. Through this study, the criteria for enlargement of the right ventricular outflow tract (RVOT) for each given body size which will produce a PRV/LV of less than 0.8 were derived in 1971. If the size of the RVOT after infundibulectomy and valvotomy is smaller than that prescribed by the criteria, an outflow patch must be placed on the pulmonary outflow tract. Since 1971, these criteria have been used in total correction of this anomaly in our affiliated hospital without any problem and have been yielding good operative results. Postoperative hemodynamic studies have shown that our criteria are suitable.