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.
de Freitas RA. Residual Risk After Tetralogy of Fallot Repair. JAMA Cardiol. 2019;4(1):41–42. doi:10.1001/jamacardio.2018.4331
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