Preoperative Correction of Coagulation in Tetralogy of Fallot

THIS preliminary report presents new information concerning the hemorrhagic diathesis which develops frequently in polycythemic, cyanotic patients with tetralogy of Fallot.1Practical suggestions are offered for its prevention. Unusual and excessive bleeding during and after surgery has been noticed since the earliest patients were operated upon for cyanotic congenital heart disease.2This bleeding diathesis may become manifest during any type of surgery,3but is particularly likely to occur in secondary cardiac operations.4Although laboratory evidence of clotting deficiencies may be found in small children, severe bleeding is clinically much commoner in adolescents and adults.1In secondary operations, the presence of vascular adhesions and extensive subcutaneous capillaries accentuates the problem.4 Various attempts to define the underlying clotting disturbances have been reported.5Thrombocytopenia,6low activity of the prothrombin complex,7and poor clot retraction8have been the most frequently seen abnormalities. Abnormal thromboplastin