Transventricular Repair of Tetralogy of Fallot

Although in the widest definition, tetralogy of Fallot includes pulmonary atresia and ventricular septal defect (VSD), only the ‘simple’ form [i.e., right ventricular outflow tract obstruction (RVOTO) and VSD] will be considered. Historically, the results of repair in infancy were poor and surgeons tended to palliate infants requiring surgery and undertake correction later (e.g., at about 4 years of age). In the early 1970s, following the lead of Barratt-Boyes, 1 other surgeons started to repair those babies presenting with severe cyanosis or spells who would otherwise have been palliated. 2,3 The reason these babies became cyanotic early was because they had narrower outflow tracts and therefore were more likely to need a transannular outflow patch. Because results have been good, many surgeons are now repairing all their patients in infancy with excellent outcomes.