Total correction after the Brock procedure

Abstract

In 1968, Lord Brock retired from the staff of the Brompton Hospital. Attending the out-patient clinic at that time were a number of patients all of whom, having been born with tetralogy of Fallot, had subsequently had an infundibular resection. In many ways these patients were similar. The first thing was that they were all alive and this of course was due to the brilliant pioneering surgery of Lord Brock in the early 1950s. Secondly, they were probably the products of parents who refused to accept the inevitable for their children at that time and who brought them from all over the country to Brock for operation. Probably because of that background, these patients, having been at least partially corrected, went on to have a good education, some going to university. Most of them had good jobs and some of them were married and had family responsibilities. The problem then was what to do with these patients attending outpatients. Did they require a fuller correction and if so when should this be done? Most, in fact, were expecting a further operation at some stage and they were naturally worried about when this should be because of their family and work responsibilities. Clearly the main problem was that with a large ventricular septal defect their right ventricle was at systemic pressure. The question was, ‘Could this be tolerated?’ Those who had a less than optimal correction were still cyanosed and they were presumably also at risk from cerebral embolism and cerebral abscess. Those who had more than an optimal correction were left with a large left-to-right shunt and they were at risk from pulmonary hypertension. In deciding which patients should be advised to have an operation there was also concern about the operative mortality and morbidity. As it happened, sufficient patients attended with severe enough symptoms to advise operation. At present 15 patients have had a further operation. Of these eight were female, seven were male and they were aged between eight and 46 years. The two youngest aged eight and 11 were from other surgeons, referred subsequently. The mean age was 24 years (Table 12.1).