Ventricular Function and Pulmonary Insufficiency

During surgical correction of congenital defects such as tetralogy of Fallot, which include severe pulmonary stenosis, it is sometimes necessary to produce pulmonary valvular incompetence in order to obtain a right ventricular outflow tract of adequate diameter. Some published data indicate that pulmonary insufficiency is well tolerated in animals,1,2but other data indicate that it is associated with pronounced right ventricular failure.3 In a recent review of our own data over the past several years, the creation of severe pulmonary insufficiency in patients seemed associated with increased mortality and morbidity, and there was suggestive evidence that patients with residual pulmonary stenosis did better than those with widely opened right ventricular outflow tracts. In fact, total abolition of the systolic gradient between right ventricle and pulmonary artery seemed, in a small series of patients with significant pulmonary insufficiency, to be strongly associated with severe right-sided failure or even post-operative