The First Open Heart Corrections of Tetralogy of Fallot

Abstract

Tetralogy of Fallot became a correctable malformation on August 31, 1954, and from that data through 1960, 106 patients (ages 4 months-45 years) who underwent open repairs at the University of Minnesota and were discharged, have been followed (99% complete) until death or for 26-31 years (mean: 23.7 years, 2424 patient years). The purposes of this study were to determine survival, morbidity, hemodynamics, educational/employment attainments, and relation of these to surgical technics. Operations were done by cross circulation (6 patients) and bubble oxygenator (100 patients). This group had the first uses of patch ventricular septal defect closure, outflow root, infundibuloplasty, atresia correction, ischemic arrests, and pacemakers among other innovations. Twenty-one (of 105 patients) have died during the followup: eight deaths in the first 10 years, 12 between 10 and 20 years, and 1 greater than 20 years. The causes of death were sudden (5), accidental (4), congestive failure (2), reoperation (2), suicide (2), and other (2). Actuarial survival at 30 years was 77%. Late complications were ten reoperations, five arrhythmias, and one endocarditis. Actuarial freedom from reoperations at 30 years was 91%. Cardiac recatheterizations in 62 patients disclosed only 10 with residual shunts. Peak right ventricular systolic pressures were less than 40 mmHg (34 patients), 41-60 mm (2 patients), 61-70 mm (4 patients), greater than 71 mm (4 patients). Thirty-four patients (32%) completed college, ten of these completed graduate school (5 masters degrees, 2 M.D.'s, 2 Ph.D.'s, 1 lawyer). Fifteen others attended college, and nine received technical school diplomas. Forty patients (18 men, 22 women) had progeny, with 82 (93%) live births and six major cardiac defects (7.3%). In summary, complete repair gave excellent late results in this group cared for very early in the open heart era. Survivors led productive lives without restrictions in education and employment. Many of the deaths/complications that occurred are now easily preventable, which augurs extremely well for this generation.

Tetralogy of Fallot Repair in Patients 40 Years or Older

“…Surgical repair of TOF has been performed since 1955. 2 Early primary repair has been recommended since the 1970s and is now routinely performed with excellent results. 3 However, we still occasionally encounter patients who have not undergone repair or have had only a palliative procedure; these patients thus are considered for surgical correction later in life.…”

Arrhythmias Late After Repair of Tetralogy of Fallot-A Japanese Multicenter Study-

“…Several studies from Western countries have reported the prevalence of late arrhythmias and their significance in long-term prognosis and quality of life in this patient population. [2][3][4][5][6][7][8] In Japan, Kobayashi et al reported a single institute's experience of arrhythmias analyzed by Holter monitor in postoperative TOF, 9 and recently, Niwa et al reported a Japanese survey on the quality of life in adult patients with postoperative TOF, including some data on arrhythmias. 10 These Japanese studies, however, are not comparable with the studies from Western countries in terms of the number of subjects and length of follow-up.…”

Long-term outcome of patients undergoing surgical repair of isolated pulmonary valve stenosis. Follow-up at 20-30 years.

“…4,[7][8][9][10] This report describes the longer follow-up (at least 20 years or until death) of the operative survivors of 183 patients who underwent surgical repair of isolated pulmonary stenosis. Particular attention is given to the influence, on results, of age at operation, of use of a right ventriculotomy, of right ventricular systolic pressure (before and after operation), and of the presence of a murmur of pulmonary insufficiency after operation.…”