Reconstruction of the right ventricular outflow tract in patients with tetralogy of Fallot: early and late results.

Total correction of tetralogy of Fallot was performed on 161 consecutive patients between 1966 and 1979. Forty-four per cent had undergone a previous palliative operation. A right ventricular outflow patch was used in 58% of the patients. In about half of these cases, the patch extended across the pulmonary annulus onto the main pulmonary artery and in five per cent it extended beyond the pulmonary bifurcation. The overall operative mortality was 13%, for patients less than three years of age it was 38% and for patients three years and older 11%. Operative mortality was chiefly related to an unrelieved right ventricular hypertension. The use of an outflow patch did not influence the operative mortality. Eight survivors (6%) were re-operated upon, six due to residual outflow obstruction, one due to residual ventricular septal defect and in one patient re-operation was indicated because of neo-intimal thickening in a tubular dacron graft. Inadequate infundibulectomy (one patient), narrow pulmonary annulus (two patients), calcified valve remnants (two patients) and a ridge in the posterior wall of the main pulmonary artery (two patients, one of whom underwent two re-operations) were the anatomical bases for the obstructions. It is concluded that at total correction of tetralogy of Fallot every effort should be made to relieve the right ventricular outflow obstruction, even if the pulmonary valves have to be sacrificed. If the pulmonary artery is hypoplastic or has localized stenosis, the pulmonary annulus should be incised and an outflow patch carried all the way to the pulmonary artery branches.