RESUMO
In this study, we investigated the chemical composition, and antioxidant and antibacterial properties of ethanolic extracts of propolis (EEP) from Melipona quadrifasciata quadrifasciata and Tetragonisca angustula. Chemical composition of EEP was determined by colorimetry and chromatographic (HPLC-DAD and UPLC-Q/TOF-MS/MS) analysis. Antimicrobial activity of EEP was evaluated against gram-positive (S. aureus, methicillin-resistant S. aureus, E. faecalis) and gram-negative (E. coli and K. pneumoniae) bacteria by the minimal inhibitory concentration (MIC) test using the microdilution method. Furthermore, the growth curve and integrity of cell membrane of S. aureus and E. coli were investigated using standard microbiological methods. HPLC-DAD analysis showed that the EEP of M. quadrifasciata quadrifasciata has a more complex chemical composition than the EEP of T. angustula. Moreover, UPLC-MS analyses of M. quadrifasciata quadrifascita indicated flavonoids and terpenes as major constituents. The bactericidal activity of both EEPs was higher against gram-positive bacteria than for gram-negative bacteria. The EEP from M. quadrifasciata quadrifasciata presented MIC values lower than the EEP from T. angustula for all tested bacteria. The EEP from M. quadrifasciata quadrifasciata caused lysis of the bacterial wall and release of intracellular components from both E. coli and S. aureus. Our findings indicate that the chemical composition of propolis from stingless bees is complex and depends on the species. The extract from M. quadrifasciata quadrifascita was more effective against gram-positive than gram-negative strains, especially against S. aureus and methicillin-resistant S. aureus compared to T. angustula extract, by a mechanism that involves disturbance of the bacterial cell membrane integrity.
Assuntos
Antibacterianos/farmacologia , Antioxidantes/farmacologia , Abelhas/classificação , Bactérias Gram-Negativas/efeitos dos fármacos , Própole/química , Animais , Antibacterianos/isolamento & purificação , Antioxidantes/isolamento & purificação , Cromatografia Líquida de Alta Pressão , Colorimetria , Bactérias Gram-Negativas/classificação , Bactérias Gram-Positivas/classificação , Testes de Sensibilidade Microbiana , Espectrometria de Massas em TandemRESUMO
OBJECTIVES: To collate data from multiple obsessive-compulsive disorder (OCD) treatment centers across seven countries and five continents, and to report findings in relation to OCD comorbidity, age of onset of OCD and comorbid disorders, and suicidality, in a large clinical and ethnically diverse sample, with the aim of investigating cultural variation and the utility of the psychiatric diagnostic classification of obsessive-compulsive and related disorders. METHODS: Researchers in the field of OCD were invited to contribute summary statistics on current and lifetime psychiatric comorbidity, age of onset of OCD and comorbid disorders and suicidality in their patients with OCD. RESULTS: Data from 3711 adult patients with primary OCD came from Brazil (n=955), India (n=802), Italy (n=750), South Africa (n=565), Japan (n=322), Australia (n=219), and Spain (n=98). The most common current comorbid disorders were major depressive disorder (28.4%; n=1055), obsessive-compulsive personality disorder (24.5%, n=478), generalized anxiety disorder (19.3%, n=716), specific phobia (19.2%, n=714) and social phobia (18.5%, n=686). Major depression was also the most commonly co-occurring lifetime diagnosis, with a rate of 50.5% (n=1874). OCD generally had an age of onset in late adolescence (mean=17.9years, SD=1.9). Social phobia, specific phobia and body dysmorphic disorder also had an early age of onset. Co-occurring major depressive disorder, generalized anxiety disorder and psychotic disorders tended to have a later age of onset than OCD. Suicidal ideation within the last month was reported by 6.4% (n=200) of patients with OCD and 9.0% (n=314) reported a lifetime history of suicide attempt. CONCLUSIONS: In this large cross-continental study, comorbidity in OCD was common. The high rates of comorbid major depression and anxiety disorders emphasize the need for clinicians to assess and monitor for these disorders. Earlier ages of onset of OCD, specific phobia and social phobia may indicate some relatedness between these disorders, but this requires further study. Although there do not appear to be significant cultural variations in rates or patterns of comorbidity and suicidality, further research using similar recruitment strategies and controlling for demographic and clinical variables may help to determine whether any sociocultural factors protect against suicidal ideation or psychiatric comorbidity in patients with OCD.
Assuntos
Transtornos Mentais/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Suicídio/psicologia , Adulto , Idade de Início , Austrália/epidemiologia , Brasil/epidemiologia , Comorbidade , Feminino , Humanos , Índia/epidemiologia , Internacionalidade , Itália/epidemiologia , Japão/epidemiologia , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/psicologia , África do Sul/epidemiologia , Espanha/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Individuals with obsessive-compulsive disorder (OCD) and separation anxiety disorder (SAD) tend to present higher morbidity than do those with OCD alone. However, the relationship between OCD and SAD has yet to be fully explored. METHOD: This was a cross-sectional study using multiple logistic regression to identify differences between OCD patients with SAD (OCD+SAD, n=260) and without SAD (OCD, n=695), in terms of clinical and socio-demographic variables. Data were extracted from those collected between 2005 and 2009 via the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders project. RESULTS: SAD was currently present in only 42 (4.4%) of the patients, although 260 (27.2%) had a lifetime diagnosis of the disorder. In comparison with the OCD group patients, patients with SAD+OCD showed higher chance to present sensory phenomena, to undergo psychotherapy, and to have more psychiatric comorbidities, mainly bulimia. CONCLUSION: In patients with primary OCD, comorbid SAD might be related to greater personal dysfunction and a poorer response to treatment, since sensory phenomena may be a confounding aspect on diagnosis and therapeutics. Patients with OCD+SAD might be more prone to developing specific psychiatric comorbidities, especially bulimia. Our results suggest that SAD symptom assessment should be included in the management and prognostic evaluation of OCD, although the psychobiological role that such symptoms play in OCD merits further investigation.
Assuntos
Ansiedade de Separação/epidemiologia , Ansiedade de Separação/psicologia , Transtorno Obsessivo-Compulsivo/psicologia , Adulto , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/epidemiologia , PrevalênciaRESUMO
Trata-se de um estudo com abordagem quantitativa, com o objetivo de investigar o uso de plantas medicinais em crianças na faixa etária de zero a 12 anos internadas no Hospital Infantil Arlinda Marques, da cidade de João Pessoa (PB), entre agosto de 2000 a junho de 2001. Um roteiro de entrevista semi-estruturado foi empregado junto aos 132 acompanhantes das crianças para a obtenção dos dados. Os resultados evidenciaram que as doenças que mais acometeram as crianças foram: 1) pneumonia (26 por cento), 2) infecções intestinais (13 por cento), 3) anemia (8 por cento), 4) afecções renais (7 por cento). Cerca de 27,3 por cento dos acompanhantes usaram plantas medicinais em suas crianças antes de procurarem o Serviço Hospitalar e 41,7 por cento associaram plantas com alguma medicação. Diante destes resultados pode-se concluir que a utilização de plantas medicinais em crianças para o tratamento de doenças possui seus riscos e benefícios que precisam ser avaliados pelos profissionais de saúde.
The aim of this study is to investigate the use of medicinal plants in children of zero to 12 years hospitalized in the "Hospital Infantil Arlinda Marques", City of João Pessoa, State of Paraíba, Brazil between August 2000 and June 2001. For the collection of the data a half-structuralized script interview was applied to 132 children's companions. The results evidenced that the illnesses which mostly affected the children were: 1) pneumonia (26 percent), 2) infections of the intestines (13 percent), 3) anemia (8 percent), 4) kidneys illnesses (7 percent). About 27,3 percent of the companions had used medicinal plants in the children before going to the hospital service; 41,7 percent had associated plants with some medicines. Based on this, it can be concluded that the use of medicinal plants in children for the treatment of illnesses has its risks and benefits that need to be evaluated by health professionals.
RESUMO
The importance of personality psychopathology has been recently recognized, since it may influence the manifestation and prognosis of the other psychiatric conditions. The systematic evaluation of patients for personality disorders (PD) has been favored by some structure instruments developed in the past few years. The aim of this study was to translate into Portuguese and evaluate the applicability and interrater reliability of the "Structure Interview for DSM-III-R Personality Disorders" (SIDP-R). The subjects were 40 patients with DSM-III-R obsessive-compulsive disorder (OCD) and 40 nonpsychiatric patients from a university outpatient service. All 80 interviews were made simultaneously by two raters, with independent scoring. The coefficient of agreement (Kappa) was calculated for nine individual PDs and ranged from 0.55 to 1.00. The OCD patients had significantly (p <0.01) more PDs (70 percent) than the nonpsychiatric group (15 percent). No significant sex differences were found in the prevalence of PDs. There was much diagnostic overlap, specially between avoidant and dependent PDs. The Portuguese version of the SIDP-R had good applicability and satisfactory interrater reliability and may be a useful instrument to assess axis II disorders
Assuntos
Humanos , Feminino , Masculino , Adolescente , Adulto , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtornos da Personalidade/classificação , Escalas de Graduação PsiquiátricaRESUMO
BACKGROUND: Late postoperative arrhythmias and right ventricular dysfunction may occur after classic repair of tetralogy of Fallot. METHODS AND RESULTS: During a mean follow-up of 8.9 years (range, 5 to 14 years), 24-hour ambulatory electrocardiographic studies were done in 107 patients after repair of tetralogy of Fallot. Radionuclide angiography was performed in 97, and 78 patients also underwent postoperative heart catheterization. The patients were divided into two groups: group A consisted of 71 patients aged 2 months to 61 years (mean, 6.8 years) in whom the right ventricular approach was used; group B included 36 patients aged 8 months to 39 years (mean, 7.9 years) whose repair was through the right atrium. A transannular patch was employed in 42 (59.2%) patients in group A and in 23 (63.9%) patients in group B. Eighteen patients were adults (> 18 years old) at the time of surgery: 13 (18.3%) in group A and 5 (13.8%) in group B. During a mean follow-up of 9.7 years, 57 (80.3%) group A patients were in New York Heart Association (NYHA) functional class I. Atrial flutter was present in 3 (4.2%) patients, and 28 (39.4%) had significant ventricular arrhythmias (> or = Lown grade 2). Postoperative heart catheterization showed good hemodynamic results in 36 of 54 group A patients studied (12 of whom had ventricular arrhythmias); moderate-to-severe pulmonary regurgitation was present in 14 (25.9%) patients; only 2 (3.7%) patients had right ventricular hypertension. On electrophysiological study, 8 of 28 (28.6%) patients in group A had inducible sustained ventricular tachycardia. Despite antiarrhythmic therapy, 2 of these patients died suddenly, presumably from ventricular arrhythmias. Two other late deaths in group A were caused by heart failure. During a mean follow-up of 7.2 years, 33 of 36 (91.7%) patients in group B were in NYHA functional class I. Atrial flutter was not found in any patient in this group. Only 1 (2.8%) patient, who had moderate-to-severe pulmonary regurgitation, had significant ventricular arrhythmias (> or = Lown grade 2). Postoperative catheterization showed good hemodynamic results in 20 of 24 patients; 3 (12.5%) had moderate-to-severe pulmonary regurgitation, and 1 (4.2%) patient had right ventricular hypertension. Sustained ventricular tachycardia could not be induced in any of the 5 adult patients who underwent electrophysiological studies. One late death (caused by endocarditis) occurred in group B. CONCLUSIONS: The right atrial approach significantly reduced the risk of life-threatening ventricular arrhythmias after repair of tetralogy of Fallot (P < .001) without increasing the incidence of supraventricular arrhythmias. Right ventricular dysfunction and severe pulmonary regurgitation were also more prevalent (P < .01) when the right ventricular approach was used.
Assuntos
Arritmias Cardíacas/etiologia , Complicações Pós-Operatórias/epidemiologia , Tetralogia de Fallot/cirurgia , Disfunção Ventricular Direita/etiologia , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/epidemiologia , Cateterismo Cardíaco , Estimulação Cardíaca Artificial , Criança , Morte Súbita Cardíaca/epidemiologia , Eletrocardiografia Ambulatorial , Seguimentos , Imagem do Acúmulo Cardíaco de Comporta , Átrios do Coração/cirurgia , Ventrículos do Coração/cirurgia , Humanos , Complicações Pós-Operatórias/diagnóstico , Fatores de Risco , Fatores de Tempo , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/epidemiologiaRESUMO
Primary cardiac tumors of the ventricles are very uncommon. During an 8-year period only, nine such patients were encountered: the tumor was primarily in the right ventricle in six, in the left ventricle in two and biventricular in one. There were seven children and two adults in this series. Histologically, the neoplasm was benign in all patients. The tumor was obstructive in six patients, five of whom underwent surgery (complete resection in three, partial excision in one and a Fontan-Kreutzer procedure in one); one neonate died before an operation could be performed. In addition, one patient with an epicardial tumor underwent complete resection. There were no early or late deaths among the six patients treated surgically. The tumor was small and non-obstructive in two patients, who were not operated on: one died suddenly, and the other was followed without intervention. In summary, complete or partial excision of ventricular neoplasms can usually be accomplished with good long-term results. If resection is not possible, effective palliation may be achieved with a Fontan-type operation, excluding the right ventricle from the circulation.
Assuntos
Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/cirurgia , Lipoma/cirurgia , Mixoma/cirurgia , Rabdomiossarcoma/cirurgia , Adulto , Pré-Escolar , Evolução Fatal , Feminino , Fibroma/congênito , Fibroma/diagnóstico por imagem , Fibroma/patologia , Seguimentos , Neoplasias Cardíacas/congênito , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Ventrículos do Coração/anormalidades , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Lactente , Recém-Nascido , Lipoma/congênito , Lipoma/diagnóstico por imagem , Lipoma/patologia , Masculino , Mixoma/congênito , Mixoma/diagnóstico por imagem , Mixoma/patologia , Gravidez , Rabdomiossarcoma/congênito , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/patologia , Ultrassonografia Pré-NatalRESUMO
Between September 1980 and August 1988, 21 patients, of mean age 7.3 (range 1-19) years, with ventricular septal defect and aortic valve prolapse, underwent surgery. Aortic insufficiency was mild in three patients, moderate in 13 and severe in five. Surgical repair was performed using a combined transaortic and transpulmonary approach. The prolapsed leaflets were evaluated through the ventricular septal defect before and after valvuloplasty. Using the Trusler technique, the prolapsed cusps were plicated at the level of the commissures; only one patient required aortic valve replacement. After functional assessment of the valve repair, through the ventricular septal defect, during infusion of cardioplegia in the aortic root, the defects were closed through the pulmonary artery, or through a right atriotomy. Mean follow-up was 51.5 (range 3-108) months. One patient developed bacterial endocarditis and died 3 months after surgery. The other 20 patients remained symptom-free. There are no residual ventricular septal defects, and mild residual aortic insufficiency is present in six patients. The mean(s.d.) cardiothoracic ratio decreased from 0.61(0.07) before to 0.49(0.05) after surgery. In summary, preservation and repair of the prolapsed aortic valve is possible even in the presence of severe aortic insufficiency. The combined approach through both great arteries enables good visualization with minimal traction, and accurate assessment of the aortic valvuloplasty through the ventricular septal defect. In addition, problems associated with a right ventriculotomy are avoided.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Comunicação Interventricular/cirurgia , Adolescente , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/patologia , Aorta Torácica/cirurgia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Valva Aórtica/cirurgia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/patologia , Aortografia , Criança , Pré-Escolar , Cineangiografia , Feminino , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/patologia , Hemodinâmica/fisiologia , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/patologia , Artéria Pulmonar/cirurgiaRESUMO
Fourteen patients with scimitar syndrome, aged from 4 days to 20 years, underwent surgical treatment between September 1980 and August 1988. Patients were separated into two groups. Group A comprised four neonates with heart failure and severe pulmonary hypertension; part of the right lung was supplied by large aberrant systemic subphrenic arteries (ASSAs) in each. Group B included ten patients (nine children and one adult) with mild to moderate symptoms, normal pulmonary artery pressures; only two had ASSAs. In group A, one neonate with multiple ventricular septal defects underwent pulmonary artery banding but later required a lobectomy because of a lung abscess. The other three neonates underwent ligation of ASSAs; two improved rapidly, and one died of sepsis. In group B, all patients survived intracardiac repair and remain asymptomatic during a follow-up of 24 to 108 (mean 54.9) months. In summary, prognosis after intracardiac repair is excellent in patients without pulmonary hypertension. Neonates with heart failure usually improve after ligation of ASSAs, and pulmonary resection is only indicated in patients with intractable pulmonary sequestrations.
Assuntos
Síndrome de Cimitarra/cirurgia , Adolescente , Adulto , Anastomose Cirúrgica , Sequestro Broncopulmonar/diagnóstico por imagem , Sequestro Broncopulmonar/mortalidade , Sequestro Broncopulmonar/cirurgia , Criança , Pré-Escolar , Feminino , Seguimentos , Átrios do Coração/cirurgia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/cirurgia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/mortalidade , Hipertensão Pulmonar/cirurgia , Lactente , Recém-Nascido , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/mortalidade , Veias Pulmonares/anormalidades , Veias Pulmonares/cirurgia , Radiografia , Síndrome de Cimitarra/diagnóstico por imagem , Síndrome de Cimitarra/mortalidade , Técnicas de SuturaRESUMO
In cases of interrupted aortic arch type A, the end-to-end aortic anastomosis can be enlarged with a left subclavian flap. In type B interruption, the divided left carotid artery is anastomosed to the distal aorta, and the anastomosis can be augmented with a reversed left subclavian flap. These techniques provide a tension-free, much wider, and noncircumferential anastomosis with potential for growth. Using a combined lateral and anterior approach, the duration of circulatory arrest for the intracardiac repair is minimized.
Assuntos
Aorta Torácica/anormalidades , Aorta Torácica/cirurgia , Anastomose Cirúrgica/métodos , Pré-Escolar , Constrição Patológica , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Retalhos Cirúrgicos/métodosRESUMO
A right submammarian incision with anterior thoracotomy was performed in 89 female patients to repair simple and complex forms of atrial septal defects. Patients' ages ranged from 8 to 38 years (mean 21.5 years). Seventy-seven had secundum-type atrial septal defects, one had the primum type, and 11 had an associated partial anomalous pulmonary venous connection. The patients were divided into two groups: 57 patients in group A, in whom, after a breast flap was elevated, a transpectoral approach was used to enter the chest; 32 patients in group B, in whom the pectoral muscle was not divided and a subpectoral approach was used. Aortic cannulation was accomplished without difficulty in all 89 patients. There were no early or late deaths in either group. Follow-up ranged from 24 to 108 months (mean 63.7 months) and included 86 patients, who were free of symptoms. In group A, however, among 54 patients examined, the volume of the right breast and pectoral muscle was smaller than the left in four patients (7.4%), and 21 (38.8%) had persistent right periareolar numbness. In 32 patients evaluated in group B, no difference was noted in the size of the breasts, and persistent numbness was present in four patients (12.5%). In summary, atrial septal defects or anomalous pulmonary venous connections can be safely repaired through a right submammarian thoracotomy in female patients. The subpectoral approach offers better results because breast asymmetry and paresthesias are significantly less prevalent (p less than 0.01).
Assuntos
Comunicação Interatrial/cirurgia , Músculos Peitorais/cirurgia , Veias Pulmonares/anormalidades , Toracotomia , Adolescente , Adulto , Mama , Criança , Feminino , Seguimentos , Humanos , Complicações Pós-Operatórias , Fatores Sexuais , Retalhos Cirúrgicos , Fatores de TempoRESUMO
Between September 1980 and August 1988, 47 patients younger than 12 months (27 neonates and 20 infants) underwent repair of aortic coarctation. Three surgical techniques were used: patch aortoplasty (group A: 5 neonates and 3 infants, mean age 4.5 months), subclavian flap (group B: 11 neonates and 8 infants, mean age 3.1 months), and the combined resection-flap procedure (group C: 11 neonates and 9 infants, mean age 2.7 months). There were 8 early deaths (3 in group A, 3 in group B, and 2 in group C) and 2 late deaths (both in group B), all of which occurred in patients with complex coexisting anomalies. Follow-up included 37 patients (5 in group A, 14 in group B, and 18 in group C) and ranged from 28 to 108 months (mean 68.0, 60.8, and 51.7 months, respectively). Residual arm-leg pressure gradients greater than 10 mm Hg were detected in 4 of 5 patients in group A, 11 of 14 patients in group B, and 1 of 18 patients in group C (p less than 0.005). There were no reoperations in any infant operated on after 1 month of age in any group (0% risk). However, 4 patients who underwent repair during their neonatal period, with recurrent gradients greater than 20 mm Hg, have required reoperation: in group A, 1 of 5 patients (20% risk) (1 of 2 neonates or 50% risk); in group B, 3 of 14 patients (21% risk) (3 of 9 neonates or 33% risk); and none in group C (0% risk in infants and neonates) (p less than 0.001). In summary, residual gradients and risk of recoarctation are significantly higher when a patch or a subclavian flap had been used for repair. The combined resection-flap procedure (an end-to-end anastomosis enlarged with a subclavian flap) is more effective in avoiding gradients and preventing recoarctation, especially in neonates.
Assuntos
Coartação Aórtica/cirurgia , Artéria Subclávia/cirurgia , Retalhos Cirúrgicos/métodos , Anastomose Cirúrgica , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Prevalência , Recidiva , Fatores de RiscoRESUMO
Total correction of tetralogy of Fallot was performed without a ventriculotomy in 39 patients aged 8 months to 39 years (mean age, 9.1 years) between May 1984 and July 1988. A transatrial approach was used to resect the obstructed infundibulum and to close the ventricular septal defect. In 14 patients, the pulmonary annulus was not enlarged (group 1). Twenty-five patients required a transannular patch (group 2), placed by extending the pulmonary artery incision 1 cm into the right ventricular infundibulum. Eleven patients had repair of pulmonary artery branch stenosis, and associated intracardiac anomalies were simultaneously corrected in 10 patients. After repair, the right ventricular to left ventricular systolic pressure ratios ranged from 0.36 to 0.59 (mean ratio, 0.45) in group 1 and 0.33 to 0.70 (mean ratio, 0.51) in group 2. There were no hospital or late deaths in group 1. Two patients in group 2 with a small left ventricle died shortly after operation. The 37 survivors were followed for 2 to 51 months. Postoperative catheterization in 7 patients detected no residual ventricular septal defects, mild pulmonary regurgitation in 2 patients (group 2), and right ventricular to left ventricular pressure ratios ranging from 0.25 to 0.42 (mean ratio, 0.34). Only 1 patient with a previous total repair by ventriculotomy is symptomatic and requires antiarrhythmic agents and diuretics. The other 36 patients are asymptomatic. In conclusion, tetralogy of Fallot can be safely repaired at any age without a ventriculotomy. The results indicate a minimal incidence of postoperative arrhythmias and pulmonary regurgitation, as well as improved right ventricular function.