Relationship between Polycythemia and Surgical Mortality in Patients Undergoing

SELECTION of the most suitable operation for patients with Fallot's tetralogy should be based upon a knowledge of the risk involved. Results of the Blalock-Taussig operation have been thoroughly studied.1 Shunt operations can be performed with good knowledge of general risk to the patient and with assurance that the result will most often be dramatic and recovery prompt. At best, however, the result is palliative, and longterm observation of patients following this procedure suggests that it is effective for a limited time only.2 3 In contrast, surgical cardioplasty with complete correction of the defect has not been so well evaluated. Certainly, operative risk is much greater with complete correction. The theoretic desirability of plastic surgical reconstruction of the heart is obvious, however, and evaluation of these patients a year or more after surgical treatment suggests that the long-term results will be good.4 We observed that the risk of corrective operation in patients with tetralogy of Fallot who were severely cyanotic was higher than in those who were less cyanotic. Patients who had been severely cyanotic and who had benefited from a systemic-pulmonary shunt seemed to tolerate complete correction with fewer deaths than those "post-shunt" patients