The clinical anatomy of tetralogy of Fallot

It is now well over one hundred years since Arthur Louis Etienne Fallot showed that four discrete morphologic abnormalities co-existed in the majority of patients he had autopsied with “la maladie bleu”,1 or cyanosis as we now describe it. The lesions he identified were an interventricular communication, subpulmonary stenosis, biventricular origin of the aortic valve, and right ventricular hypertrophy. We now know that the combination of these anomalies had been recognised long before Fallot's epochal description. Indeed, it is Neils Stensen, the Danish monk who also described the parotid duct, who is usually acknowledged as being the first to describe the entity that we now call tetralogy of Fallot.2 Cases were certainly described by John Hunter,2 whilst with the benefit of hindsight, we can see an unequivocal example illustrated by the Baron von Rokitansky3 in his ground-breaking atlas (Fig. 1).