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The Journal of Thoracic and Cardiovascular Surgery, Vol 74, 382-395, Copyright © 1977 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association


ARTICLES

Surgical management of pulmonary stenosis in tetralogy of Fallot

AD Pacifico, JW Kirklin and EH Blackstone

Fifty-five consecutive patients with the tetralogy of Fallot underwent intracardiac repair in a 12 month period. A standardized protocol for outflow tract enlargement was used. When the measured diameter of the pulmonary valve ring was at least the "minimum acceptable pulmonary valve ring diameter," primary patch-graft enlargement across the valve ring was not done (Group I, 34 patients); when it was less, primary patch-graft enlargement was done (Group II, 21 patients). The right ventricular-left ventricular systolic pressure ratio (PRV/LV) after repair without patch-graft enlargement across the ring was related to the size of the ring. Sixteen (94 percent) of 17 such patients with normal-sized or large pulmonary valve rings (according to the criteria of Rowlatt, Rimoldi, and Lev) had PRV/LV equal to or less than 0.65; four (80 percent) of five patients with smaller rings but within the 50 percent confidence limits had PRV/LV equal to or less than 0.65; five (56 percent) of nine with still smaller rings but within the 72.5 percent confidence limits had PRV/LV equal to or less than 0.65. In Group II, 15 patients had abnormally small rings, but after patch-graft enlargement the mean PRV/LV was 0.44 +/- 0.140. A surgical protocol based on these data has been developed.


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