Blalock-Taussig Anastomosis for Tetralogy of Fallot: A Ten-to-Fifteen Year Follow-Up

Abstract

The mortality rate for total correction of Fallot's tetralogy on cardiac bypass with or without a Blalock-Taussig anastomosis is still relatively high (Kirklin et al., 1959;Lillehei et al., 1957; Taussig et al., 1962). Favourable reports concerning the results of the Blalock-Taussig procedure in patients followed for five to ten years have been published (Taussig and Bauersfeld, 1953;Campbell and Deuchar, 1953;White et al., 1956;Rumel, 1958;Brock, 1959;Shumacker and Mandelbaum, 1960). While total correction is the ideal, the mortality rate must be weighed against the long-term beneficial effects of the safer Blalock-Taussig operation.In the present investigation we have studied the results of the Blalock-Taussig operation performed ten or more years ago in the United Birmingham Hospitals and have compared them with the outcome in a group of untreated patients with Fallot's tetralogy over the same period. We were also interested in the effects of a left-to-right shunt, created after birth, on the underperfused pulmonary circulation, since the occasional development of pulmonary hypertension has been reported in some of these patients (Leeds, 1958;Ross, Taussig, and Evans, 1958;Epstein and Naji, 1960;Ferencz, 1960;Paul, Miller, and Potts, 1961;McGaff, Ross, and Braunwald, 1962). PATIENTS AND METHOD Between the years 1948 and 1952 the diagnosis of Fallot's tetralogy was made in 42 patients. The diagnosis was based upon clinical signs and confirmed by cardiac catheterization and/or angiocardiography both before operation and again during the present investigation. In 30 of the patients, the disability was so great or was increasing so fast that operation was performed in or before the year 1952. The remaining 12 patients were less disabled and operation was not therefore recommended. The subsequent course of these two groups, henceforth referred to as the treated and untreated groups respectively, has been followed.The treated group consisted of 30 patients, and 20 (67%Y) have survived for a mean period of 11 9 years (range 10-15). Their ages at the time of operation ranged between 4 and 37 years (mean 10-3). The remaining 10 are known to have died. Of the surviving patients, 19 have been studied and one refused investigation, although we have full details of his present clinical condition. There were 13 male and 7 female patients whose ages ranged from 14 to 37 years (mean 22-2) at the time of study. The untreated group comprised 12 patients (6 male and 6 female) whose ages ranged between 3 and 27 years (mean 11 -7) when first seen. Excluded from this study were patients diagnosed in or before 1952, not operated on then, but operated upon since 1952.At the time of the follow-up investigation in the treated group each patient was examined and exercise tolerance was graded according to the New York Heart Association (1953). Special investigations included hemoglobin concentration and heematocrit measurement, electrocardiogram, phonocardiogram, and chest radiograph. Seventeen patients had cardiac catheterization which...

The Blalock-Taussig Shunt

“…Compared with the untreated patients, the results of the B-T shunts in 30 patients with tetralogy of Fallot between 1948 and 1952 showed that 67% of the patients survived with clinical improvement and were leading a relatively normal life. 42 Subsequently, the B-T shunts obtained a permanent improvement during a 10-to 15-year follow-up. 43,44 However, the effectiveness of the 4-mm-diameter conduit was doubted due to the occurrence of conduit failure at one year after implantation, while other sized conduits remained widely patent.…”

“…Compared with the untreated patients, the results of the B‐T shunts in 30 patients with tetralogy of Fallot between 1948 and 1952 showed that 67% of the patients survived with clinical improvement and were leading a relatively normal life 42 . Subsequently, the B‐T shunts obtained a permanent improvement during a 10‐ to 15‐year follow‐up 43,44 …”

Left arm structure and function late after subclavian flap repair of aortic coarctation in childhood

“…20 Abnormalities in blood flow, arm length and grip strength have also been demonstrated in ipsilateral arm of patients with Blalock Taussig shunts. 21,24 However, these results have not been uniformly demonstrated, with Shenberger et al 7 finding no difference in blood flow nor static forearm strength, 9 years after subclavian flap repair.…”

Changes in Muscle Blood Flow and Development of the Arm Following the Blalock-Taussig Anastomosis

“…Nevertheless, disturbances in the blood supply and develop ment of the arm on the side of the anastomosis have been reported in follow-up studies [3,5], However, there is no evidence in the literature for abnormalities of muscle blood supply in the operated extremity.…”