The present indications of palliation in Fallot’s tetralogy

Two years ago at this Conference we had an interesting session on the treatment of Fallot’s Tetralogy and at that time I spoke for our Unit at Great Ormond Street and made out what we thought was a good case for palliative procedures in certain infants with Fallot’s tetralogy. These were the ones under six months of age who were in severe trouble and would not survive under the best medical care. We showed what we thought was a good case with a low mortality rate for shunt procedures in this very selected group of babies. At that time, two years ago, we produced our figures going back to 1953. We showed an overall mortality rate of 16% in a total of 401 shunts of various kinds in children with Fallot’s tetralogy. I then gave the more up to date figures which are relevant and our shunts for Fallot’s tetralogy in infants from 1970 to 1972 showed that our mortality rate had improved enormously. It was difficult to be sure whether this was due to better postoperative care, or better surgical technique but from a total of 54 shunts in this period we only had three deaths and they were probably explainable for other reasons than the cardiac lesion.