[Total repair of tetoralogy of Fallot in an adult: report of a case without prior treatment at 59 years of age].

We reported successful repair of tetoralogy of Fallot of a male case aged 59 years old. There was no palliative operation prior to this correction. The preoperative clinical features were as follows: dyspnea on effort and at rest, cyanosis and clubbing, multiple cerebral thrombosis without symptoms. Polycytemia was remarkable at Hb 23.3 g/dl and Ht 73.8%. PaO2 was 39.2 mmHg and hypoxemia was recognized. CTR was 59% and pulmonary vascular shadows were decreased but bilateral pulmonary arteries were well developed. Cardiac catheterization showed that high RV systolic pressure equal to that of LV and severe RV outflow obstruction. Pulmonary artery was well developed (the diameter ratio of PA and aorta: 0.84). Collateral arteries to the pulmonary vascular system were not significant by aortography. The surgical procedures were performed under conventional method. Pulmonary valvular stenosis was released by comissurotomy and RV outflow tract obstruction was also released through minimal right ventriculotomy. The conus branch of coronary artery crossed the outflow tract, so that we preserved this artery for preventing right ventricular failure post-operatively. There was no need to use trans-annular patch for reconstruction of the outflow tract. In post operative course, only a low dosage of catecholamin was required but no other special treatment was needed. Ventricular and supraventricular arrhythmia had appeared in short period but after administration of anti arrhythmic drugs, heart rhythm was converted to sinus rhythm easily. Pathological findings of RV muscle which resected at the operation showed marked fibrous degeneration and irregularity of cells, and it suggested that sever hypoxia and high pressure for long time affected the ventricular muscle. We concluded that even older patients of tetralogy of Fallot were corrected safely and were able to get good quality of life after operation.