Surgical correction of tetralogy of Fallot (TOF) after palliative operations.

Patients with tetralogy of Fallot and unfavorable anatomy of the right ventricular outflow tract or hypoplastic pulmonary arteries may require primary palliation and subsequent repair (two-stage repair). The concept of palliation includes improvement of the lung perfusion and relief of systemic hypoxia by means of some type of arteriopulmonary arterial shunt or a Brock-type operation. At repair a previously constructed aorto-pulmonary anastomosis has to be closed, which can be done without increased risk for hospital death or postoperative morbidity.