The current role of palliative operations in the surgical treatment of tetralogy of Fallot. A report on 172 operated cases

172 consecutive palliative operations in patients with Fallot's tetralogy are presented. 19% of the patients were aged less than 6 and 45% less than 12 months. The overall mortality was 5.8%, but has been recently reduced with the improvement of anaesthesiologic and technical experience. In fact, during the last two years, 69 Waterston shunts (33 under 12, and 17 under 6 months of life) were performed with no deaths. On the grounds of this experience, indications of the different types of systemic to-pulmonary artery shunts are discussed, as well as problems related to the choice between one-stage and two-stages surgical correction. The authors' opinion is that palliative procedures still play an important role in the treatment of Fallot's tetralogy, although the future approach may well be early total correction. In their experience, the last approach is restricted to children over 18-24 months of life with favorable anatomy, and to all patients over 4 years of age.