Second operations for pulmonary stenosis or insufficiency after repair of tetralogy of Fallot.

Twenty-four patients with previous surgery for repair of tetralogy of Fallot were in need of subsequent operative procedures for either residual pulmonary stenosis or pulmonary valve incompetence. The second operation was performed 1 to 21 years after the initial repair. The patients with pulmonary valve incompetence had evidence of marked right ventricular dysfunction and required pulmonary valve replacement. The patients with residual pulmonary stenosis had modifications of their pulmonary outflow tract to reduce the gradient. Five of the 15 patients with stenosis required pulmonary valve replacement. Clinical improvement has been good, but objective reversal of right ventricular dysfunction has been difficult to document.