Sixty Years After Tetralogy of Fallot Correction.

This report describes one of the early cases of open surgical correction of tetralogy of Fallot performed by C. Walton Lillehei and colleagues at the University of Minnesota and discusses findings from the patient's follow-up 60 years later.

Tetralogy Surgery - Back To Baltimore 70 Years Later: Melbourne Heritage and Group Tribute to Juan Comas.

Surgery for Tetralogy of Fallot progressed rapidly from the palliative arterio-pulmonary Blalock-Taussig shunt, introduced in Baltimore 70 years ago, to the "classic" complete transventricular repair technique, with which excellent early results were achieved soon thereafter. However, as duration of follow-up increased, so did the awareness of development of troubling late complications, including severe pulmonary insufficiency, right ventricular dilatation and dysfunction, and tricuspid valve insufficiency, all contributing to increasing incidence of late reoperations, as well as to arrhythmias and sudden death. This realization fueled the initial introduction of the transatrial-transpulmonary repair technique by Kawashima, as well as the subsequent firm establishment of this technique within the framework of an integrated surgical approach by Roger Mee in Melbourne. In turn, Mee's numerous trainees and associates led the dissemination of this approach and provided the impetus for the current wide adoption of a variety of right ventricular and pulmonary valve preservation techniques. In addition to the outstanding surgical results reported by individual centers adopting this surgical strategy, encouraging multi-institutional data are emerging regarding the benefits of these approaches for more favorable early and, most importantly, late outcome. One student and strong proponent of the Melbourne approach was our late colleague and friend Juan Comas, to whose memory this article can serve as tribute.

Etienne-Arthur Louis Fallot and his tetralogy.

Étienne-Arthur Louis Fallot (1850-1911) is one of the most significant medical figures of the 19th century with an eponymous congenital cardiac malformation. His initial account of the four anatomical features making up his tetralogy proved remarkably significant in the progression of clinical descriptions of the lesions producing cyanotic congenital cardiac disease. Although subsequently the cause of appreciable controversy, the accuracy of his initial descriptions underscore the current diagnostic and therapeutic approach to the malformation now known uniformly as tetralogy of Fallot.

"The heart is simply a muscle" and first description of the tetralogy of "Fallot". Early contributions to cardiac anatomy and pathology by bishop and anatomist Niels Stensen (1638-1686).

BACKGROUND: Many are familiar with the parotid duct and the Danish physician/anatomist's name associated with it. However, most are unaware of Niels Stensen's life and his significant contributions to the early study of the heart. For example, he found that the heart is simply muscle and was the first to describe what we now refer to as the tetralogy of Fallot. METHODS: A review of germane literature regarding this pioneer of cardiac anatomy was performed. CONCLUSIONS: This physician of the Medici court was clearly ahead of his time and found errors in the publications of such giants as Varolius and Willis. The tetralogy of Fallot should rightfully, be termed the tetralogy of Stensen. The present review discusses the life of this 17th century anatomist, physician and priest/bishop and highlights his contributions to cardiac anatomy and pathology.

[Arthur Fallot (1850-1911) and blue disease]. / Arthur Fallot (1850-1911) et la maladie bleue.

Arthur Fallot (1850-1911) described for the first time the so-called "maladie bleue", or "blue disease". His discovery was published in Marseille Médical, and therefore remained little known. Present cardiologists know what they owe him and therefore call "tetralogy of Fallot" this congenital heart condition.

[Fallot and his tetralogy]. / Fallot en zijn tetralogie.

Etienne-Louis Arthur Fallot's (1850-1911) private and professional life were restricted to Marseille. He described a tetralogy of cardiac abnormalities that often underlies cyanosis ('maladie bleue') in children and young adults: stenosis of the pulmonary artery, defect in the interventricular septum, hypertrophy of the right ventricle and overriding aorta. This combination had been described several times before, but Fallot was the first to recognise the consistency and pathophysiological interrelationship of the four abnormalities.

Update on tetralogy of Fallot for the adult cardiologist including a brief historical and surgical perspective.

There has been a steady rise in the prevalence of severe congenital heart disease (CHD) in adults because of improved treatment and survival during childhood. This has resulted in a shift in CHD morbidity and mortality beyond 18 years of age. The healthcare community must be prepared to meet this new challenge. Adult cardiologists need to be aware of common CHD, such as tetralogy of Fallot (TOF), as they will encounter adults with this CHD in their practice. With routine monitoring, cardiac imaging, early intervention, and treatment as highlighted in this report, continued improvement in the long-term fitness and avoidance of late complications for adult TOF patient is anticipated.

Tetralogy of fallot: yesterday and today.

Tetralogy of Fallot (TOF) is a cyanotic congenital cardiac defect that was first described by Stenson in 1672 and later named for Fallot, who in 1888 described it as a single pathological process responsible for (1) pulmonary outflow tract obstruction, (2) ventricular septal defect (VSD), (3) overriding aortic root, and (4) right ventricular hypertrophy. The surgical history of TOF began with the development of the systemic to pulmonary artery shunt (BT shunt) by Blalock, Taussig, and Thomas in 1944. Ten years later complete repair of TOF was performed by Lillehei using cross-circulation and by Kirklin with a primitive cardiopulmonary bypass circuit. Notable contributions by several other surgeons including Bahnson, Ebert, Malm, Trusler, Barratt-Boyes, and Castaneda would lead us into the modern era of surgery. Today, complete repair of TOF is performed before six months of age with low mortality (<2%). In select cases a modified version of the BT shunt is still performed as the initial procedure. Long-term survival rates are excellent (85%-90%). Adult survivors with TOF are an ever-increasing population and may require reintervention, surgically or catheter based. Promising future innovations include percutaneous pulmonary valve replacement, tissue-engineered autologous valves and conduits, and genetic manipulation. This article presents a review of TOF, including the history of surgical treatment, present-day approaches, and long-term outcomes.

The first Stella van Praagh memorial lecture: the history and anatomy of tetralogy of Fallot.

Stella Van Praagh, MD (1927-2006) of Children's Hospital Boston was one of the greatest pediatric cardiologists and pediatric cardiac pathologists of the 20th and early 21st centuries. Née Stella Zacharioudaki from Crete, Greece, in addition to her stellar professional attainments, she was also an outstanding cuisinière, hostess, linguist, philosopher, and philanthropist. In 1962, she married Richard Van Praagh, MD, beginning a life-long collaboration that was in every sense an affaire de coeur. They had three children and seven grandchildren. Dr Stella was the author of more than 110 scientific publications which helped to clarify the pathologic anatomy, the clinical and laboratory diagnosis, and often the surgical management of many different forms of congenital heart disease, including dextrocardia, single ventricle, truncus arteriosus, tetralogy of Fallot (TOF), transposition of the great arteries, double-outlet right ventricle, sinus venosus defect, anomalous pulmonary venous drainage, the heterotaxy syndromes with asplenia or polysplenia, juxtaposition of the atrial appendages, and apical muscular ventricular septal defect. In 1999, Dr Stella Van Praagh received the Distinguished Achievement Award of the Society for Cardiovascular Pathology, and in 2004, she was honored with the Paul Dudley White Award of the American Heart Association. Dr. Stella Van Praagh was that vanishingly rare combination of brilliant clinician, internationally renowned medical scientist, and deeply cultivated humanist. The anomaly now known as the TOF was first described by Niels Stensen in 1671, with other early reports by Edouard Sandifort (1777), William Hunter (1784), and many others. In 1888, Etienne-Louis Arthur Fallot published five serialized contributions in Marseille Médical concerning what he called the "blue malady," in which he described the now classical tetralogy of pulmonary outflow tract obstruction, ventricular septal defect, aortic overriding, and right ventricular hypertrophy. The other outstanding feature of Fallot's report was its emphasis on clinicopathologic correlation. In 1924, Maude Abbott coined the term "tetralogy of Fallot." In 1970, Van Praagh and colleagues presented the concept that the TOF is basically just one anomaly, a failure of normal expansile growth of the subpulmonary infundibulum and its sequelae. The anatomy of TOF is presented angiocardiographically, diagrammatically, and anatomically. A morphometric study of typical neonatal TOF is presented, based on 16 autopsied heart specimens with age-matched normal controls. The morphometric study documents that TOF is characterized by a low-volume subpulmonary infundibulum. The diagnostic and surgical significance of these findings is highlighted. Two rare and recently discovered forms of TOF are presented: tetralogy {S,D,I}, and tetralogy {I,D,S}. Because tetralogy {I,D,S} has atrioventricular discordance, in addition to a standard TOF repair, such patients also need an inverted (mirror-image) atrial switch operation (inverted Senning or inverted Mustard procedure). Because associated malformations can be very important to the surgical outcome of patients with tetralogy, the associated anomalies found in 100 randomly selected autopsied cases are presented.

[Fallot, Blalock and Taussig - the 'blue babies' odyssey]. / Fallot, Blalock i Taussig - czyli odyseja "niebieskich dzieci"

120 years ago, Louis Fallot described a congenital heart malformation consisted of a special constellation. This was a cyanotic malformation, hence the term 'the blue baby syndrome'. In 1949 there was a first trial of correction of tetralogy of Fallot by joining pulmomary artery with subclavial artery. This vessels connection was fixed in medical terminology as Blalock-Taussig shunt.

"Tetralogy of Fallot" and Etienne-Louis Arthur Fallot.

The eponym "tetralogy of Fallot" did not become a common noun in pediatric cardiology vocabulary for several decades after Etienne-Louis Arthur Fallot's report in a French medical journal. There were others before Fallot who described the abnormal cardiac anatomical findings seen in tetralogy of Fallot, but his name became fixed to the condition's eponym primarily through Maude Abbott popularizing the term.

Something the Lord Made.

When Alfred Blalock (1899-1965), the pioneer Hopkins surgical professor, saw the pulmonary artery suturing technique that his laboratory technician, Vivien Thomas (1910-1985), had just performed in a dog, his level of astonishment was so high that he expressed, "Vivien, this looks like Something the Lord Made." In all his years of practice, Dr. Blalock had never seen anything like it before. The level of perfection was so superior to other works that it could not be considered to be of human descent. The surgical technician far exceeded anyone else in the surgical department. In due time, he taught surgical residents and faculty the exquisite details of the laborious vascular suturing techniques. Thomas and Blalock learned to respect and appreciate each other's work. Thomas, the advanced student, and Blalock, the noted teacher, learned to understand one another and recognize their unique abilities. With the support and theoretical advice of his mentor, Thomas proceeded in the old Hunterian Laboratory to solve the problem of the Blue Baby heart disease, also known as Tetralogy of Fallot. The fruits of Thomas's work were put to a test on November 29, 1944, when surgeon-in-chief Blalock took baby Eileen to room 706 to perform the first pulmonary artery to subclavian artery shunt in humans. The results were especially good, and baby Eileen recovered satisfactorily. It was obvious that history had been made, and Thomas and Blalock were the creators, the heroes of this extraordinary feat. They had participated together in Something the Lord Made.