Reoperation after correction of tetralogy of Fallot.

Forty-one patients underwent reoperation after total correction of tetralogy of Fallot from 1962 through 1979. The indications for surgical repair were recurrent or residual lesions alone or in combination with other lesions. The reoperation consisted of closure of a residual ventricular septal defect (VSD) in 28 patients, relief of residual right ventricular outflow tract (RVOT) gradient in 11, tricuspid value replacement, repair or annuloplasty in six, aneurysmorrhaphy or excision of an RVOT aneurysm in five, insertion of a right ventricular-pulmonary artery valved conduit in five, insertion of an RVOT valve in three, closure of a patent foramen ovale or atrial septal defect in three, repair of a residual surgical shunt in three, mitral valve replacement in one patient, and aortic valve repair in one. Thirty-eight patients (93%) survived the operation. The surgical mortality decreased from 25% during 1962 through 1970 to 0% during 1971 through 1979 (p = 0.02). There was one late death. Five patients (12%) required a second-reoperation for recurrent VSD. Even a small residual shunt, especially when associated with other defects such as pulmonary insufficiency or tricuspid insufficiency, may cause clinical deterioration that can be improved by reoperation. This study tends to support the policy of recommending reoperation when either RVOT obstruction (gradient greater than or equal to 50 mm Hg) or isolated VSD (Qp/Qs greater than 1.5) is present. Reoperation is associated with a low mortality and good long-term results.