ROUTINE PRIMARY REPAIR OF TETRALOGY OF FALLOT IN NEONATES AND INFANTSLESS-THAN 3 MONTHS OF AGE

Background. Although primary repair of tetralogy of Fallot is increasi ngly undertaken in infancy, complete repair is generally performed in only selected symptomatic neonates. Methods. From July 1992 through Ma rch 1995, 30 consecutive neonates and young infants with tetralogy of Fallot underwent routine primary repair. Group I (n = 10) consisted of patients with tetralogy of Fallot and pulmonary atresia (n = 5) or se vere pulmonary stenosis (n = 5) who were duct dependent and were repai red in the neonatal period. Group II (n = 11) consisted of patients wh o were asymptomatic with arterial oxygen saturation between 75% and 90 % (adequate pulmonary blood now). Group III (n = 9) consisted of patie nts with ''pink'' tetralogy of Fallot (arterial oxygen saturation >90% ). Patients in groups II and III were electively scheduled for repair at about 2 months of age. Results. The postrepair peak systolic right ventricular-to-peak systolic left ventricular pressure ratio did not c orrelate (p = 0.96) with the branch pulmonary artery size. One patient died 2 months after operation, despite good hemodynamics, of uncontro llable diffuse subcutaneous edema due to familial distichiasis lymphed ema syndrome. There were no late deaths. At a median follow-up of 19 m onths, 1 patient underwent balloon dilation of branch pulmonary arteri es. Follow-up echocardiography revealed a 30 to 60 mm Hg right ventric le-to-pulmonary artery gradient in 3 patients. Conclusions. Excellent early and midterm results can be accomplished with routine primary rep air of tetralogy of Fallot in early infancy regardless of age, symptom atic status, coronary anatomy, and the size of branch pulmonary arteri es as long as they arborize normally.