THE BROCK PROCEDURE (CLOSED INFUNDIBULAR RESECTION) FOR FALLOTS TETRALOGY - 43 YEARS LATER

Innovative cardiac surgery ('blind' or indirect infundibular resection ) for tetralogy of Fallot on a child of 4 years was followed by surviv al for 43 years without further surgery. The patient remained well unt il about one year before death, when he developed clinical features of progressive biventricular failure associated with pulmonary hypertens ion and incompetence of the pulmonary and tricuspid valves. Postmortem examination showed severe damage to one of the leaflets of the pulmon ary valve, interpreted as due to inadvertent avulsion during the origi nal surgical procedure. A large ventricular septal defect was present, but there was no residual subpulmonary infundibular obstruction.