From January 1996, to November 1997, 15 consecutive infants ranging in age from 3 to 11 months (mean: 6 months) and weigh ing from 5 to 9 kilograms (mean: 7.2 kilograms) underwent elective total repair of tetralogy of Fallot. Thirteen had symptoms of hypoxemia and two were acyanotic. Definitive diagnosis was established in all cases by two-dimensional echocardiography. Intracardiac correction was accomplished with conventional cardiopulmonary bypass and moderate hypothermia. Myocardial protection was obtained by cold cristaloide cardioplegia infused into the aorta and topical hypothermia of the heart. Bypass time ranged from 50 to 125 minutes (mean: 84 minutes) and aorta cross clamp time ranged from 32 to 86 minutes (mean: 56 minutes). Intracardiac repair was accomplished through right ventriculotomy in 14 cases and by a transatrial approach in one. A right ventricular outflow patch was used in 11 cases but was extended across the pulmonary valve ring only in four. Transannular pulmonary gradient after correction ranged from 2 to 25 mmHg (mean: 12 mmHg). There were no deaths or major complications in this series. It is concluded that intracardiac correction of the tetralogy of Fallot in the first year of life may be accomplished with low mortality and may have advantages over the two-stage approach.
Tetralogy of Fallot; Tetralogy of Fallot
