Tetralogy of fallot

ABSTRACT

The management and results of 72 consecutive patients with TOP during a 4-year period at the AUBMC are presented. Thirteen patients had a systemic to pulmonary artery shunt performed prior to total repair. Fourteen other patients required shunts during the same period, of whom 5 were done on an emergency basis after a cardiac catheterization. The operative mortality rate in 27 patients during the last 2 years of this survey was 7%, whereas the previous mortality rate in 45 patients during a comparable period was 11%. The operative mortality rate in shunted patients was 15% after total repair vs. 10% in non-shunted patients. The indications for shunt procedures in this retrospective survey were anomalous LAD crossing RVOT, repeated cyanotic spells in infants less than 2 years of age, hypoplastic pulmonary arteries, unavailability of open-heart facilities, or a rare blood group rendering open-heart operation practically not safe. Eight patients [11%] had an associated anomaly of the coronaries, of whom two succumbed after total repair. Mediastinal bleeding was noted post-repair in 1 of 13 shunted patients [7.6%] versus 7 of 59 non-shunted patients [11.8%]. The use of properly tailored Gore-Tex to patch the VSD and reconstruct the right ventricular outflow tract has yielded satisfactory results. The optimal age of about one year for total primary repair of TOF is presently favored