Technical Considerations in the Correction of Fallot's Tetralogy

¹ Assistant Professor of Surgery, University of Minnesota Medical School
² Department of Surgery, University of Minnesota Medical School
³ Professor of Surgery, University of Minnesota Medical School

A corrective repair for tetralogy of Fallot cases has been used in older and larger children. For others, creation of a systemic artery pulmonary artery shunt is recommended. Specifically children small in size and under the age of five years are preferably subjected to shunt operations initially as are patients with hypoplastic pulmonary arteries.

2. A method is described ("infundibuloplasty") which frequently allows sufficient widening of the right ventricular outflow tract without the routine use of prosthetic right ventricular outflow or resection of portions of the obstructing crista supraventricularis in patients with tetralogy of Fallot.

3. In addition, "infundibulo-plasty" allows better exposure for patch closure of the awkwardly located ventricular defect of tetralogy of Fallot.

4. Technical details for closure of this ventricular communication are presented.

5. Certain steps for avoiding possible damage to the atrioventricular conduction bundle and to the septal leaflet of the tricuspid valve are emphasized.

6. Two out of the 22 patients with tetralogy of Fallot operated upon following the described technique died at operation (9 per cent). One late deaths occurred three months following the operation.

7. Only one patient had transient (11 days) atrioventricular dissociation following correction of this lesion. None of the patients had permanent heart block.