Sixty-four cyanotic patients over 15 years of age with tetralogy of Fallot have undergone total correction. Fifty-one patients had previous shunting procedures. The established intracardiac technique for total repair was used throughout. In 11% (7 of 64) of patients reconstruction of the pulmonary outflow tract was required. Follow-up extends from six months to ten years. Operative mortality was 6.25% (4 of 64). There was one late death. All deaths were technically related and none could be correlated with patient age. Bilaterally functioning Blalock shunts and Potts anastomoses contributed significantly to operative mortality. Abundant collateral circulation exists in older patients with tetralogy of Fallot, and increased bleeding in this series was reflected in a 20.3% (13 of 64) reoperation rate. Survivors represent 92.2% (59 of 64) of the group and all are completely asymptomatic. Approximately one-half of the surviving patients have undergone postoperative catheterization. Of those patients studied, 93.4% (29 of 31) have a good to excellent hemodynamic result following correction. All patients with outflow-tract patches subsequently developed pulmonary insufficiency and right-heart failure. These patients were easily managed on a cardiotonic regimen, however, and digitalis was discontinued in each case by the end of the third postoperative month. These mortality and survivor figures parallel those obtained in our total experience of 250 tetralogy repairs. We believe all patients with tetralogy of Fallot should undergo total correction. Advanced age is no contraindication to surgery. Shunting procedures, when indicated, are to be considered only a preliminary to full correction.

The aim of this audit was to determine the effectiveness of a protocol driven, nurse‐led hypertension service for patients with diabetes at high risk. Data for this audit were collected prospectively on referred patients with established diabetes complications and suboptimal hypertension control. Antihypertensive agents were sequentially introduced and dose titrated according to protocol. Patients were discharged once the target systolic blood pressure (SBP) of <140mmHg was achieved or the intended sequence of drug therapy was complete. In all, 124 patients completed the full process. There were significant reductions in SBP (186±24 to 139±12mmHg, p<0.001) and diastolic blood pressure (85±13 to 67±11mmHg, p<0.001). A total of 61% achieved the target SBP of <140mmHg. There were expected increases in the number of antihypertensive agents and the number of agents used to maximum dose. Estimated coronary heart disease risk for the primary prevention group improved significantly despite non‐significant changes in lipid profiles. It was concluded that a systematic approach combining a pre‐set drug protocol itself and its timely implementation under adequate surveillance in a nurse‐led hypertension clinic led to effective outcomes. Copyright © 2007 John Wiley & Sons.

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