Total Correction of Tetralogy of Fallot Without "Routine" Preoperative Cardiac Catheterization: Management of 99 Patients

Between January 1989 and April 1993 total correction was performed in 99 patients with tetralogy of Fallot without cardiac catheterization. Age of the patients ranged from 1.33 to 18 years (mean 5.33±3.77). After complete echocardiographic examination the diameters of the right and left pulmonary arteries at the prebranching point and descending thoracic aorta at the diaphragm were measured by 2-D echocardiography and the McGoon ratio was calculated. Total correction was performed in the patients with McGoon ratio greater than 1.7. In none of the patients the pulmonary artery sizes measured by echocardiography was smaller than the measurements obtained during surgery. Transannular patching was performed in 76 patients. 2 patients with coronary artery anomaly had right ventricular to pulmonary artery extracardiac conduit. Postrepair right ventricular to left ventricular systolic pressure ratio (RVP/LVP) was between 0.25 and 0.85 (mean 0.54±0.13). There were two hospital deaths, both were not related to the diagnostic method and indication criteria. We conclude that, diagnosis of tetralogy of Fallot and measurements of pulmonary arteries and descending thoracic aorta by echocardiography is reliable. McGoon ratio can be adapted to echocardiography and total correction can successfully be performed based on echocardiographic examination.