Management of symptomatic tetralogy of Fallot in the first year of life.

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.