The chronicle of tetralogy of Fallot is part of a dramatic evolution i
n cardiology, cardiac surgery, and understanding of the developing hea
rt. Many new tools and concepts have evolved since Steno of Denmark fi
rst described the defect in 1673, and since Fallot of Marseilles coine
d the term tetralogy in 1888. Four major eras of progress can be recog
nized. The 1st, the era of pathologic anatomy, culminated in the publi
cation of Maude Abbott's Atlas of Congenital Cardiac Disease in 1936.
The next, the era of clinico-physiology and surgery, was highlighted b
y the 1st Blalock-Taussig anastomosis in 1944, by open-heart surgery 1
0 years later, and by a new team approach to cardiology. The 3rd, or i
nfant era, began in the mid 1970s with successful intracardiac repair
in infants, the rise of echocardiography, and the introduction of pros
tagladin therapy. The current era of cardiac development (beginning in
the 1990s) gives hope for early understanding of the molecular basis
of tetralogy. Tribute is due to the surgical and medical pioneers, and
to the pioneer patients and their families, for revolutionary changes
in diagnosis and treatment. The challenge of the next 100 years lies
in increased understanding of the molecular biology of the defect and
in preserving the blend of humanism, scholarship, and skill that have
graced the advances of the past 3 centuries.