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Invited Commentary
January 2019

Residual Risk After Tetralogy of Fallot Repair

Author Affiliations
  • 1Department of Cardiology, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
JAMA Cardiol. 2019;4(1):41-42. doi:10.1001/jamacardio.2018.4331

The evolution of surgery in tetralogy of Fallot (TOF) reflects the development of congenital cardiac surgery in general. Initially, TOF surgeries offered palliation: systemic-to-pulmonary shunts that would improve pulmonary blood flow and raise oxygen saturations at the expense of continued cyanosis and a volume load on the left ventricle. Systemic-to-pulmonary artery shunts arising from the subclavian artery (Blalock-Taussig shunts) or aorta (Waterston and Potts shunts) showed very different complications over long-term follow-up. Once cardiopulmonary bypass allowed complete repair of TOF, strategies were developed to optimize different issues that were identified.