Surgical Repair of Tetralogy of Fallot With Pulmonary Atresia in Adults: Three Case Reports

We present three cases of adults who underwent late repair of tetralogy of Fallot with pulmonary atresia (ToF-PA). All three patients underwent palliative procedures at an earlier age and were not considered candidates for corrective surgery due to borderline pulmonary artery anatomy. They developed symptomatic decline with increasing dyspnea, desaturation, and decreasing exercise tolerance; thus, they were reconsidered for complete surgical repair of ToF-PA in adulthood. Improvement in symptoms and oxygen saturation were achieved in all patients. With advances in surgical techniques and cardiopulmonary bypass support, it may be worthwhile to review patients who underwent palliative procedures earlier in life but previously were thought not to be surgical candidates. The discussion for potential operative management of these patients may be possible aftercareful reassessment of pulmonary artery anatomy and ventricular function.