Long-Term Results of Aortic-Pulmonary Anastomosis for Tetralogy of Fallot

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Abstract
The first 100 consecutive patients with a diagnosis of tetralogy of Fallot upon whom an aortic-pulmonary anastomosis could be performed were subjected to a clinical and physiologic evaluation 11 to 13 years after operation. At this long-term follow-up 92 patients were traced. Nine patients died at the time of surgery and, in the period from 1946 to 1959, 10 patients died, most often from congestive heart failure. To our knowledge only three patients have required a second shunt operation to relieve recurrent cyanosis. The clinical results were considered good or excellent in 68 per cent of the survivors, fair in 30 per cent, and poor in 2 per cent. The long-term poor results and mortality were usually associated with too large an initial anastomosis leading to either left ventricular overwork and congestive heart failure or severe pulmonary hypertension and progressive pulmonary vascular obstruction. Right heart catheterization studies indicated that in a group of 18 patients in whom the pulmonary vascular bed could be evaluated, 15 patients had a normal pulmonary vascular resistance after 11 to 13 years of a clinically adequate aortic-pulmonary shunt. The role of the shunt procedures as a valuable salvage operation at the present time for a select segment of patients with tetralogy of Fallot and certain other complex cyanotic lesions is reemphasized.