SURGICAL EXPERIENCE WITH TOTAL CORRECTION OF TETRALOGY OF FALLOT IN INFANCY

Fifty two patients less than one year old with tetralogy of Fallot und erwent primary repair between January 1991 and December 1994. Age rang e was three to twelve months (mean 10.09+/-2.01 months) and body weigh t ranged from 4.5 to 9 kg (mean 8.38+/-2.79 kg). Transatrial-transpulm onary repair was performed in 36 patients and the classical transventr icular approach was used in 16 patients. Six patients underwent emerge ncy surgery for severe cyanosis and spells. Five patients had left pul monary artery plasty for pulmonary artery bifurcation stenosis and two out of the five patients who had anomalous coronary arteries needed a right ventricle to pulmonary artery conduit. Mean post repair peak ri ght ventricular/systemic pressure ratio was 0.74+/-0.18 in the transve ntricular group and 0.71+/-0.26 in the transatrial-transpulmonary grou p. There were three hospital deaths. Follow-up ranged from 3 to 46 mon ths (mean 21.18 months). Forty patients underwent echocardiography and twenty patients underwent cardiac catheterisation six to eighteen mon ths after surgery. Mean right ventricular outflow tract gradient on ec hocardiography was 20.35+/-10.12 and, at cardiac catheterisation, 17.5 1+/-13.49 mmHg with mean post repair peak right ventricle/left ventric le pressure ratio of 0.44+/-0.11. These were significantly less than t he values obtained in the operating room. Only one patient had residua l ventricular septal defect with left to right shunt of 1.6:1 at cardi ac recatheterisation. There was one late death after reoperation for r esidual obstruction. Encouraging results with primary repair of tetral ogy of Fallot in infancy prompt us to continue this policy in suitable cases.