Complete surgical repair of Tetralogy of Fallot in adults, is it ever too late? 
A minority of patients with Tetralogy of Fallot (TF) survive into adulthood.  These patients have been subjected to a prolong period of cyanosis and hypoxia.  The aim of this study is to assess the benefits of total correction of TF in this adult population.  From August 1995 to March 2005, fifty one patients underwent total correction of TF.  The mean age was 22.2 years (range 16 to 38 years).  There were 31 males and 20 females.  Twenty two percent of patients were in NYHA functional class III prior to the operation.  The mean gradient across the right ventricular outflow tract was 81.7 mmHg (range 30 to 130 mmHg).  The operation was performed through the right ventricle in the majority of patients.  Transannular patch was used in 33 patients.  The mean follow-up period was 42 months ranging from 1 to 116 months.  Hospital mortality was 1.9% (1 patient), and one patient died three months after the operation.  Post-operatively 87.3% of patients were in NYHA functional class I. During the follow-up period four patients required re-operation; two for residual ventricular septal defect, one for residual pulmonary stenosis and one had pulmonary valve replacement for severe pulmonary regurgitation.  Complete repair of TF in adults is feasible with acceptable mortality and morbidity.  The main benefit of the operation is functional improvement in this patient population.