Ventricular structure and function after radical correction of the tetralogy of Fallot.

Total, or radical, surgical correction of the tetra- logy of Fallot has now become standard practice.Mortality figures differ widely and vary from none in a series of 41 patients (Malm et al., 1963) to between 30 and 40 per cent in other hands.In 1960 Kirklin et al., reported a 17 per cent mortality in 91 patients, and in 1961 Barnard and Schrire published a similar mortality in 42 patients, though Bahnson et al. ( 1962) recorded a 30 per cent mortal- ity in 147 patients.In experienced hands today the mortality should be under 20 per cent.The main hazards of the operation relate to un- usual intracardiac deformity, complete heart block, post-operative pulmonary cedema and insufficiency, htmorrhagic problems, and incomplete correction of the lesions.Although complete heart block has become much less common with increased surgical expertise, the other hazards remain, and are appreciably greater in severely cyanotic patients with high heematocrit values, and particularly in those with a hypoplastic right ventricular outflow tract, small pulmonary valve ring, or absent crista supra- ventricularis (bulboventricular defect).The object of this paper is to present in detail the results of investigation in 24 patients following radi- cal correction.No attempt will be made to analyse the results of operation in detail in the entire series, for these results will subsequently be published in full, but brief comments will be made in order to provide a background for the detailed studies on this smaller group.Since the operation for radical correction is a complex one, and since it involves a large ventriculotomy, we felt it important to investigate fully the