Intracardiac repair of tetralogy of Fallot. Five-year review of 403 patients.

During the 5 year period 1969 to 1973, 403 patients underwent intracardiac repair of tetralogy of Fallot. The patients ranged in age from 3 months to 41 years. Before operation, 86 per cent were cyanotic and 14 per cent were acyanotic. Forty-nine per cent had had at least one palliative procedure before total correction. Mahor associated anomalies included atrial septal defect in 24 per cent, patent ductus arteriosus in 2.5 per cent, coronary anomalies in 4 per cent, and left superior vena cava in 4.5 per cent. Seven per cent of the patients had pulmonary atresia. Pulmonary valvotomy was performed in 111 patients and complete excision of the pulmonary valve in 151. Patch graft reconstruction of the right ventricular outflow tract was performed in 57 per cent of the patients. In 11 patients a conduit was used to connect the right ventricle to the pulmonary artery. The over-all hospital mortality rate was 9.5 per cent, with the lowest rate (3.5 per cent) in the age group 6 to 10 years and the highest in the infant and adult groups (16.5 and 14.5 per cent, respectively). Three known late deaths occurred. A residual ventricular septal defect (VSD) was found in 3 per cent of the patients and an aneurysm of the pericardial patch in the right ventricular outflow tract developed in 7 patients. Intracardiac repair of the tetralogy of Fallot can be performed with reasonable risk and low morbidity. In our experience the optimal age for elective surgery is between 6 and 10 years.