SURGERY OF TETRALOGY OF FALLOT PULMONARY ATRESIA WITH VENTRICULAR SEPTAL DEFECT AND TRANSPOSITION OF GREAT VESSELS

The surgery of tetralogy of Fallot is, in experienced hands, most satisfactory. Palliation can be successfully applied even in tiny infants, using a right pulmonary artery to ascending aorta anastomosis. Corrective surgery is possible in almost all patients and carries a mortality of no more than 5%, with an 80% to 90% chance of a good long‐term result. Corrective surgery is also possible in some patients with pulmonary atresia (pseudotruncus), and ventricular septal defect, although the large bronchial collateral blood flow to the lungs may produce serious post‐operative difficulties. In transposition of the great vessels, palliative surgery is most successful in Group I patients with poor intracardiac mixing and when operation is performed within one week of birth in this group the current mortality is 8%. However, the total picture of transposition surgery leaves little room for complacency. If all groups of patients are considered, only about half will survive palliative surgery for two years or longer, and in a significant percentage, particularly Groups II and III patients, later corrective surgery carries an excessive mortality. The greatest hope lies with patients having only an atrial communication, and here the risk of a Mustard repair is acceptable and can be expected to improve with increasing experience. Copyright © 1968, Wiley Blackwell. All rights reserved