Tetralogy of Fallot.

DR. AUSTIN: Well, I want to thank everybody for attending. As you may know, less than a year ago I was privileged to become a coeditor for Seminars in Thoracic and Cardiovascular Surgery, as it was thought that some input from a congenital heart surgeon would be helpful. If you look at Seminars over the past several years there have been discussions on various topics which have been primarily adult related. So my mission is to pick up the congenital side of Seminars. I was asked to gather some expert congenital surgeons for a roundtable discussion on a topic in our field about which there might be some variation in thought and management. To begin this series I chose Tetralogy of Fallot as it would easily stimulate discussion and would interest our readers into how different experts address this congenital heart defect. Chuck Fraser has been kind enough to serve as the moderator and has invited all of you to participate in this discussion. I thank all of you for coming, prepared to discuss Tetralogy of Fallot, where it is today, and where it is going. Prior to this Chuck shared with you some questions that will help focus the discussion. So from this point on, I will leave it to Chuck. DR. FRASER: Well, I'll take a stab at this. I would just open by saying that the sessions we've had here in Seattle at the AATS Congenital Course, to me, continue to reemphasize that we still have a long road ahead in the treatment of tetralogy. I thought the paper yesterday on the long-term follow-up of patients and the comparison of outcomes was spot-on in terms of timing. One thing I'll add to the list of discussion topics, with your indulgence, is that maybe we could come up with, at the end, a list of things that we think should be worked on specifically over the next decade. I'll also acknowledge that I'm going to use you guys as sort of helpful thinkers in that I've been asked to work with the AATS on a guidelines paper for pulmonary valve replacement and, of course, tetralogy is a big part of that consideration. Finally I'll say, this seems to me to be a free discussion and if people want to jump in and move into different directions, it's perfectly fine with me. Well, let's just jump right in. So let's talk about primary neonatal repair. Should we be repairing every neonate, and maybe take it a step earlier, should we prepare families, if you