title: Surgical management of tetralogy of Fallot in the first year of life.
abstract: BACKGROUND
  The surgical approach to tetralogy of Fallot (TOF) continues to evolve and now many centers favor early repair for TOF.
  
  
  METHODS
  Our experience includes 82 consecutive patients less than 1 year old with TOF (n = 74) and TOF with pulmonary atresia (n = 8) who were operated on between January 1992 and March 1998. Mean age at repair was 5.2 +/- 1.2 months and mean weight was 4.5 +/- 0.4 kg. Seven patients (anomalous left anterior descending artery [n = 1], pulmonary atresia with hypoplastic pulmonary arteries [n = 6]), underwent palliative procedures in the neonatal period followed by complete repair. Forty-nine patients (59%) were symptomatic (severe cyanosis or hypoxic spells), and 33 patients (41%) were asymptomatic. A combined transatrial-transpulmonary approach was employed in 28 patients (34%), and transannular patch or conduit for reconstruction of the right ventricular outflow tract (RVOT) was required in 54 patients (66%). The mean Nakata index was 160 +/- 25 mm2/m2.
  
  
  RESULTS
  There were no hospital deaths. Mean post-repair peak right ventricular/systemic pressure ratio was 0.48 +/- 0.1. There were no late deaths or reoperations during a mean follow-up of 23 +/- 5 months. All patients are currently asymptomatic and in New York Heart Association class 1. Postoperative evaluation by two-dimensional and Doppler echocardiography or cardiac catheterization showed minimal pulmonary artery stenosis with a mean pressure gradient of 15 +/- 6 mm Hg across the RVOT.
  
  
  CONCLUSIONS
  Our experience suggests that early repair of TOF can yield excellent results and initial palliation does not preclude early complete repair.
authors.affiliation: Department of Surgery, Louisiana State University, New Orleans, USA. jcaspi@aol.com
authors.forename: J
authors.initials: J
authors.lastname: Caspi
authors.forename: E
authors.initials: E
authors.lastname: Zalstein
authors.forename: N
authors.initials: N
authors.lastname: Zucker
authors.forename: A
authors.initials: A
authors.lastname: Applebaum
authors.forename: L H
authors.initials: LH
authors.lastname: Harrison
authors.forename: N A
authors.initials: NA
authors.lastname: Munfakh
authors.forename: H A
authors.initials: HA
authors.lastname: Heck
authors.forename: T B
authors.initials: TB
authors.lastname: Ferguson
authors.forename: A
authors.initials: A
authors.lastname: Stopa
authors.forename: M
authors.initials: M
authors.lastname: White
authors.forename: E E
authors.initials: EE
authors.lastname: Fontenot
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D010166:Palliative Care; D018633:Pulmonary Atresia / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome