Tetralogy of fallot: Managing the right ventricular outflow

Abstract

The first complete repair of tetralogy of Fallot (TOF) was reported by Lillehei in 1955 [1]. The diagram from that initial publication (Fig. 28.1) illustrates primary closure of the ventricular defect (VSD) and resection of parietal and septal muscle bundles via a generous ventriculotomy approach. Survival was a remarkable six of ten patients. While the initial cross-circulation technique of circulatory support was soon abandoned for the developing heart- lung machine, the fundamental approach for repair of TOF remained the same for the ensuing 25-30 years or more: the VSD was closed through a generous ventriculotomy and complete or near-complete relief of right ventricular outflow obstructi..