Studies of blood volume in the tetralogy of Fallot and in other types of congenital heart disease.

The recent introduction by Blalock (1) of an operative procedure for the successful treatment of the tetralogy of Fallot has focused considerable attention on the various manifestations of this condition. It has also indicated the need of more information to aid in the diagnosis and prognosis, as well as in the preoperative and postoperative treatment of the patients with this disease. The present study is concerned particularly with the measurement of blood volume, hemoglobin, and plasma protein in 7 cases of tetralogy of Fallot, 4 cases of isolated septal defect, and 1 case each of Eisenmenger complex, isolated pulmonic stenosis, coarctation of the aorta, congenital mitral stenosis, and patent ductus arteriosus. Fallot (2), in 1888, described the complex of combined congenital cardiac defects of pulmonic stenosis, right ventricular hypertrophy, patent interventricular septal defects, and dextroposition of the aorta which is commonly referred to as the "Tetralogy of Fallot." It is a common congenital defect of the heart. It constitutes 77 per cent of the 110 cases of pulmonary stenosis and 66 per cent of 40 cases of pulmonary atresia in Abbott's (3) series of 1,000 cases. The Eisenmenger complex is much less common. It differs from Fallot's tetralogy by having no pulmonary stenosis or atresia. The prognosis is somewhat better, the average life span being 16 years compared to 12.5 years in Fallot's type (4). The oldest age of survival recorded in either type is 60 years (5). The principal extracardiac pathology of Fallot's tetralogy is a generalized vascular distention, capillary hyperplasia (3), and increased tortuosity. This is accompanied by polycythemia and increased blood viscosity. Blood arteriovenous-oxygen difference is increased, and its per cent oxygen