Tetralogy of Fallot: selective surgical management can minimize operative mortality.

Although tetralogy of Fallot can be completely corrected at any age, it appears that preliminary shunting may be of benefit in infancy. To better define the optimum age for shunting, the following patient data were reviewed. One hundred five patients with tetralogy of Fallot were treated between December, 1975, and July, 1984. Eight of 100 patients undergoing intracardiac repair died. Operative mortality was 14.3% (4 of 28 patients) when intracardiac repair was done before the patient was a year old, but only 5.6% (4 of 72 patients) after that age. Seven (13%) of 54 patients requiring transannular patch reconstruction of the right ventricular outflow tract died, whereas only 1 (2.2%) of 46 having repair without this type of reconstruction died (p less than 0.05). Twenty-one patients were initially palliated with systemic-pulmonary artery shunts, with 1 noncardiac death related to associated congenital neurological anomalies (4.8%). There was no statistically significant difference in mortality for primary versus secondary intracardiac repair. Left ventricular end-diastolic volume determination in 26 patients less than 2 years old demonstrated that 14 patients had small left ventricles and that 3 of them less than 1 year of age died at corrective operation. The remaining 12 had a left ventricle of normal size, and 1 of them died at operation. Palliative shunts can be performed safely in the very young child with no increased mortality at subsequent intracardiac repair. Diffuse hypoplasia of the right ventricular outflow tract and pulmonary arteries requiring transannular patch reconstruction, and age less than 1 year both alter operative mortality, their combined impact being additive.