Tetralogy of Fallot: Radiologic Evaluation Before and After Surgical Treatment

From 1888 (1) to 1954 tetralogy of Fallot was one of many congenital cardiac diseases which held little interest for the clinician, once the challenge of diagnosis was surmounted, and offered little hope for the patient. Rarely a child survived to adulthood or even old age, but most succumbed in their teens. Blalock and Taussig (2) in 1945 first conceived the idea of an artificial ductus in the form of a subclavian-pulmonary anastomosis. Keen interest was aroused, and other operative approaches soon followed: Potts' aortic-pulmonary anastomosis in 1948 (3), Brock's infundibular resection in 1950 (4), and Lillehei's anatomic correction utilizing a heart-lung bypass in 1956 (5). This communication is based upon a review of preoperative and postoperative postero-anterior chest films of 67 patients with tetralogy of Fallot. An attempt was made to analyze cardiac size and contour and pulmonary vascularity before and after operation. Findings were tested for statistical significance when possible. Experience with a similar evaluation of the chest radiographs of patients who had undergone open heart surgery for the closure of ventricular septal defects (6) stimulated our interest in the present survey. Selection of Cases For each of the 67 cases of tetralogy of Fallot that were reviewed, postoperative films for at least one year were available. This eliminated operative deaths and operative failures with survival of less than one year and also excluded many patients from a distance who were followed postoperatively by a family physician or in some center nearer home. An original group of 231 was thus reduced to 67. Of these, 22 underwent Blalock-Taussig procedures, 40 Potts procedures, and 5 had total corrections. In 13 of the first two groups, total correction was undertaken later as a second procedure. The age range at time of surgery was one month to thirteen years. There were 29 females and 38 males. In each case the clinical evaluation and care were supervised by Dr. D. G. McNamara, and the surgery was performed by Dr. D. A. Cooley. All films reviewed were postero-anterior projections taken at 72 inches. The last film prior to surgery (usually the day before) was chosen as the preoperative film. No postoperative films within ten days of surgery were analyzed because these were usually obtained with portable units and were subject to the limitations inherent in such technics. The last available film for each patient is included in the final “Postoperative Appearance” in Table II. Preoperative Appearance Cardiac Size: Cardiac enlargement is unusual in children with tetralogy of Fallot (7–11). When found, it suggests that other associated defects may be present (11, 13, 14).