Total Correction of Tetralogy of Fallot

DURING the past two decades great strides have been made in the surgical treatment of tetralogy of Fallot. Prior to 1944, only conservative medical treatment could be offered to these patients. Since the development of the systemic-pulmonary artery shunt operation that year,1 this procedure has been extensively employed all over the world. The symptomatic relief offered by this operation is well known. This operation and its modifications, later supplemented by pulmonary infundibulectomy or valvulotomy (Brock procedure), were for 10 years the only operative procedures available. In 1955 the first patient with tetralogy of Fallot had the defect corrected by open intracardiac surgery.2 Since then rapid progress has been made in operative technics and in the methods of extracorporeal perfusion. A sufficiently large number of patients with a tetralogy of Fallot have now undergone openheart surgery to permit a preliminary evaluation of the results. This paper presents an analysis of the follow-up in the first 146 consecutive patients with tetralogy of Fallot who underwent open-heart surgery at the Johns Hopkins Hospital from September 1956 to January 1962 and who have been followed until May 1962. The surgical and perfusion technics employed in these cases have been described by Bahnson and associates,3 who also discussed many of the factors concerned in the