Hideo Matsuzawa

Reviews of corrective surgery in 126 csses of tetralogy of Fallot

One hundred and twenty-six cases , 68 male and 58 female, with tetralogy of Fallot (TF) were operated upon in this period, and 19 patients were less than 5 years of age, 52 being between 6 and 10 years of age, 37 being between 11 and 15 years of age and 18 being older than 16 years of age (Table 1). The Blalock-Taussigs systemic-pulmonary-artery anastomosis had been previously performed in 39 patients who were distributed in all age groups. Almost a l l patients but 12 showed cyanosis at rest and/or i n exercise. Of 126 cases, 17 demonstrated hemoglobin-levels were below 15 g/100 mL, 69 from 15 to 18 g/ 100 ml. and 40 more than 18 g/100 ml., respectively (Table 2). In all patients, a median sternotomy was used. A disc oxygenator was u~ed for the first 75 cases, but since 1969, cardiopulmonary bypass has been accomplished with a disposable bubble oxygenator and roller pumps utilizing the hemodilution technique. Flow rate was usually about 2.2 L/Min/M 2 and mild hypothermia from 33 to 29 degrees centigrade was applied. A transverse or a longitudinal right ventriculotomy was used according to the anatomical findings on t h e right ventricular outflow-tract, described later, and the course of the right coronary artery branches. Infundibular stenosis was removed by division and resection of the hypertrophied muscles and dilatation of the pulmonary annulus with a Tubbs-type dilator. Valvular stenosis was routinely corrected through the ventriculotomy by careful commissurotomy: However, the patients with a small pulmonary annulus and/or a hypoplastic pulmonary trunk received various types of the outflow patch, including the small Teflon fabric patch, the small or large pericardial patch and the valve retaining homoor heterologous pulmonary artery patch 2 (Fig. 1). A large ventricular septal defect was closed with a Teflon fabric patch fixed by interrupted and buttressed mattress-sutures and a specially designed clamp 5 was