title: Management of symptomatic tetralogy of Fallot in the first year of life.
abstract: The surgical management of symptomatic tetralogy of Fallot in infants is debatable. The question of total correction versus palliation and the type of palliative procedure remain controversial. During the past 4 years, 30 infants, aged 1 day to 12 months (mean 5.6 months) with symptomatic tetralogy of Fallot underwent either total correction (21 infants) or palliation by relieving the pulmonary stenosis with a right ventricular outflow tract patch (nine infants). The ratio of diameter of the right pulmonary artery to diameter of the ascending aorta (PA/Ao ratio) was calculated from the anteroposterior cineangiogram of all patients. There were three operative deaths in the total correction group; two of these occurred in infants with PA/Ao ratios less than 0.3. One death occurred in the 19 patients undergoing total correction with PA/Ao ratios greater than 0.3 (mortality rate 5.3%). All nine infants undergoing right ventricular outflow tract patching had PA/Ao ratios less than 0.3, and one operative death occurred in this group. Four patients who had right ventricular outflow tract patching have had repeat cardiac catheterization 2 to 15 months postoperatively. All four have shown symmetrical enlargement of the pulmonary arterial tree and significant increases in their PA/Ao ratios.
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology; D001027:Aortography; D002932:Cineangiography; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010166:Palliative Care; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D013771:Tetralogy of Fallot / Q000401:mortality / Q000601:surgery*