Tetralogy of Fallot

The first published report on the four features of what today is known as tetralogy is from 1671 by the Danish monk Niels Stenson, after observing the findings in an ectopic fetal heart. However, the diagnosis and early anatomic analysis of tetralogy of Fallot (TOF) are ascribed to the French physician Étienne-Louis Fallot. One of the most significant and exciting accomplishments by any of the pioneers of congenital heart surgery is the historical “blue baby operation” by Dr. Alfred Blalock in 1944. Although TOF is the most common cyanotic congenital heart defect, only a small percentage of patients present with deep cyanosis in the neonatal period following closure of the patent arterial duct. Anesthetic induction of the patient with TOF is of particular concern, as many anesthetic agents cause systemic vasodilation, which can greatly exacerbate any right-to-left shunting, possibly leading to profound hypoxia and potential hemodynamic collapse.