J.Jpn. Surg. Soc.. 80(11): 1235-1239, 1979

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Report on the annual meeting

OPERATIVE CONSITERATIONS IN REPAIR OF TETRALOGY OF FALLOT

The surgical repair of tetralogy of Fallot is one of the most rewarding procedures in surgery. Total correction of this malformation requires attention to three basic surgical problems: (1) relief of right ventricular outflow tract stenosis, (2) closure of VSD, and (3) closure of the infundibulotomy.
In all cases, right ventricular outflow patch was employed in order to enlarge the tract. The patch was often extended across the pulmonary valve ring into the main pulmonary trunk. Pig's pericardium was used instead of patients' own.
Subsequent pulmonary insufficiency was not a problem from the long-term follow-up study.
The size of VSD patch should be large enough. The diameter of patch is recommended larger by 5 mm than the diameter of VSD.
Elastic surgical suture was used around catheters which were inserted directly into the right or left atrium.
In 1978, 62 patients with this anomaly were repaired. Two patients died during the admission. Admission death rate was 3 percent. There was no case with permanent A-V Block.
However, one thirds of operated cases showed residual left to right shunt through patched VSD in the postoperative cardiac catheterization.
Authors insist VSD closure should be done much more carefully. Ten spagetties should be uesd at least to close the defect.

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