Differential diagnosis includes primary pulmonary causes of cyanosis, along with other cyanotic
heart lesions, such as critical pulmonary stenosis and transposed arterial trunks. Neonates who
present with ductal-dependent flow to the lungs will receive prostaglandins to maintain ductal
patency until surgical intervention is performed. Initial intervention may be palliative, such as
surgical creation of a systemic-to-pulmonary arterial shunt, but the trend in centres of excellence
is increasingly towards neonatal complete repair. Centres that undertake neonatal palliation will
perform the complete repair at the age of 4 to 6 months. Follow-up in patients born 30 years ago
shows a rate of survival greater than 85%. Chronic issues that now face such adults include
pulmonary regurgitation, recurrence of pulmonary stenosis, and ventricular arrhythmias. As the
strategies for surgical and medical management have progressed, the morbidity and mortality of
those born with tetralogy of Fallot in the current era is expected to be significantly improved.