The surgical correction of Fallot's tetralogy.

The success of total repair of tetralogy of Fallot depends on a clear understanding of the morbid anatomy and deranged hemodynamics of this anomaly, which consists essentially of two abnormalities, namely, a large unrestrictive ventricular septal defect and a severe obstruction to the outflow of the right ventricle. The ventricular septal defect acts as a safety valve and, therefore, cannot be closed unless the obstruction to the outflow of the right ventricle is adequately relieved. In severe cases, this often necessitates reconstruction of the outflow. With an adequate bypass technique and a clear understanding of the principles described in this article, complete correction of tetralogy of Fallot can be accomplished with a low mortality. In a series of 100 consecutive patients presented, the mortality was only 3%.