The Tetralogy of Fallot

In the 69 years since the classical description of the tetralogy of Fallot,1a "characteristic" clinical picture has evolved. The wide variability of this syndrome, however, is not generally known, but is dependent upon the severity of the anatomical defects and fluctuating functional reactions of each patient. The purpose of this report is to discuss some "unusual" clinical manifestations of this complex, illustrated by short case histories. The material is drawn from only 32 cases, emphasizing that such findings are not rare. The diagnosis was verified in all but two by at least two of the following methods: (1) cardiac catheterization, (2) angiocardiography, (3) operation, (4) autopsy. Patients were selected partially by the adequacy of the clinical data. History, physical examination, x-rays, fluoroscopy, electrocardiograms, and routine laboratory work were available in all. Twenty-five were examined by at least one of us. Phonocardiograms, cardiac catheterization, and operative findings were available