The tetralogy of Fallot in older persons up to the fifth decade: Results of subclavian-pulmonary anastomosis with a five- to ten-year follow-up

Abstract

1. 1. Eight patients with the tetralogy of Fallot, including one patient with the pentalogy of Fallot, treated by a subclavian-pulmonary artery anastomosis have been followed up five to ten years (average, eight years) following operation. The patients now are twenty-one to forty-six years of age. 2. 2. Three of the seven patients with a classic tetralogy and a shunt operation have had complications which are discussed in detail. The complications include alteration in the shunt manifested by the murmur becoming inaudible. In one patient there was probably organic occlusion of the shunt. In the second patient late defunction of the artificial ductus occurred secondary to the development of pulmonary hypertension. This was proved by direct measurement of the blood pressure in the pulmonary artery. Other complications were subacute bacterial endocarditis, brain abscess probably secondary to cerebral thrombosis and acute left heart failure in the course of prolonged labor. 3. 3. It is concluded that at the present time there may be indications for shunt procedures in certain instances. Open operations have a higher risk than shunt procedures in certain categories of the tetralogy. It is recognized that in the future, when the mortality of open operations is further reduced, there will be fewer indications for anastomotic operations.