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Surgical repair of tetralogy of Fallot

IN THIS ISSUE OF THE JOURNAL, WE PUBLISH TWO accounts of surgical repair of tetralogy of Fallot, both of which report outstanding results.As is discussed in both papers, the appropriate age for total repair, the need for a so-called "transannular" patch placed across the anatomic junction between the infundibular musculature and the pulmonary trunk (in reality a transjunctional patch), and the best approach for repair remain contentious issues. To put the issue into perspective, in our own centre we have performed repair for 228 consecutive cases using the so-called "conotruncal", or outlet, approach. This involves closing the ventricular septal defect with a patch sutured either to the membranous flap (#1 suture in Fig. 1) or to a posteroinferior muscle bar, if present, and not using the septal leaflet of the tricuspid valve. We also insert a patch across the ventriculo-pulmonary junction, of which the subpulmonary part is short, made of xenopericardium, or else use a polytetrafluorethylene monocusp. Among 228 cases, 11% were under 12 months of age, 33% were between one and two years old, 28% were three to four years old, and 28% were over four years old. Of our most recent 100 cases, 60% were under the age of two years. Twenty cases had coexisting pulmonary atresia rather than pulmonary stenosis. There was no incidence of hospital death. Late death has occurred in two cases. The first death was due to pneumonia, which occurred after reoperation for repair of residual partially anomalous pulmonary venous connection. The second patient had suffered left heart failure caused by injury to a coronary artery during division of pericardial adhesions, and died one year after surgery. All 228 patients showed sinus rhythm postoperatively, without any incidence of heart block. No patient