Although the natural course of tetralogy of Fallot is not yet clear, the life-span seems to be short except in rare cases of mild pulmonary stenosis or in cases associated with a sizeable systemic-pulmonary anastomosis. Two hundred and nine patients with tetralogy of Fallot underwent operation in the Department of Thoracic Surgery, University of Tokyo. The Blalock-Taussig operation was performed in 137 patients between 1951 and 1965. Total surgical mortality was 9% (3.5% in recent years). Analysis of 124 patients surviving an average of 5.5 years postoperatively showed that 45% of patients were still doing well, 4% had fair results, 12% exhibited no improvement, 15% required a second operation (either a second anastomosis or total correction), and 10% died of cerebral embolism, cardiac failure, or other causes (there are no details on the remaining 5% who survived). Total correction was carried out in 72 patients between 1955 and 1965. In nine of these cases, a shunt procedure had been performed previously. Total surgical mortality was 50% (19% in recent years). Surgical mortality of total correction from the world literature has fallen impressively due to improvement of surgical technique and selection of patients, but it is still higher than that of the Blalock-Taussig operation. Clinical improvement of 36 surviving patients, however, was much greater and more complete after total correction than after the Blalock-Taussig operation, although final evaluation of total correction must await long-term follow-up studies. Functional capacity and exercise tolerance have improved in the great majority of patients after total correction. Arterial oxygen saturation, hemoglobin concentration, and the hematocrit value have returned to normal values in almost all cases.
- © 1968 American Heart Association, Inc.