Pulmonary Stenosis with Left-to-Right Shunt: A Physiological Variant of Fallot's Tetralogy

¹ The Department of Medicine (Variety Club Heart Hospital), University of Minnesota Hospitals.

1. Eight adult cases with pulmonary stenosis, ventricular septal defect, and predominant left-to-right shunt have been studied clinically and physiologically.

2. In only one instance was there cyanosis at rest. This occurred in a man, age 53, who presented clinically as a straight-forward tetralogy of Fallot. The fact that the shunt is still bidirectional may in part account for his unusual longevity.

3. This combination of lesions seems to be relatively benign and to be accompanied by a good prognosis both for functional capacity and long-term survival.

4. This lesion is theoretically and actually completely correctible with surgical techniques now at hand. The risk, however, seems to be excessive at the present time in view of the relatively small degree of functional impairment present in this syndrome.

5. The proper term for designating such cases would seem to be the descriptive one of pulmonary stenosis, ventricular septal defect, and preponderant left-to-right shunt. However, in view of the cumbersomeness of this descriptive title it would seem preferable and permissable to refer to such cases as "acyanotic tetralogy of Fallot."