The Journal of Thoracic and Cardiovascular Surgery, Vol 76, 321-335, Copyright © 1978 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Surgical treatment of tetralogy of Fallot with pulmonary atresia
O Alfieri, EH Blackstone, JW Kirklin, AD Pacifico and LM Bargeron Jr
Thirteen (16 percent) of 80 patients with tetralogy of Fallot and pulmonary
atresia undergoing corrective operations between Jan. 1, 1967, and Jan. 1,
1978, died in the hospital. The hospital mortality rate was 13 percent (10
deaths) among the 77 patients with confluent right and left pulmonary
arteries. The risk of operation was not significantly affected by age at
operation or by use of a valved external conduit versus a transannular
outflow patch. It was affected (p = 0.008) by the ratio of peak right
ventricular to left ventricular pressure (PRV/LV) immediately after repair.
This (PRV/LV) was determined primarily by size of left and right pulmonary
arteries. An equation was developed relating postrepair PRV/LV to diameter
of right and left pulmonary artery (normalized by dividing by size of
descending thoracic aorta), body surface area, and possible arborization
abnormalities and stenoses of the right and left pulmonary arteries.
Cardiac performance after repair was better in those in whom a transannular
patch was used rather than a valved external conduit. Important pulmonary
dysfunction postoperatively occurred more often in patients with large
"bronchial" arteries than in those without them, but was less when these
were not ligated. Four (8 percent) of 48 traced hospital survivors died
late postoperatively. Reoperations late postoperatively were required only
in patients receiving valved external conduits. Forty (91 percent) of 44
living traced patients are asymptomatic.
