“The Brock Operation” as Initial Palliation for the Tetralogy of Fallot

Abstract

At the recent meeting (June 1978) of the European Cardiovascular Society in Lyon, France, to our surprise a number of discussants enthusiastically endorsed the use of the closed "Brock procedure" for initial palliation of the tetralogy of Fallot. In none of the centers in which we work has this procedure of closed infundibular resection and pulmonary valvotomy been done for the tetralogy of Fallot for many years. No data was presented to support the enthusiasm of the discussants, so we have reviewed the literature concerning this.The risk in recent years of shunting operations of the Blalock-Taussig and Watenton types is known, not only in toto but also according to the age of the patient at operation (1, 3, 6, 13, 15,24,30). Information of this type must be available to determine the applicability of any palliative procedure, for we know that about 35 % of persons born with tetralogy of Fallot will require surgical treatment within the first year of life and about 45 % within the first 2 years of life (5). We also know that the rist of any palliative or corrective cardiac operation done when the patient is a few months of age may be very different from that at 5 years of age.tween age and risk of operation, but such data do not exclude the possibility that the risk would be higher in the early months of life. From what we have, we can only conclude that the risk of the closed Brock procedure for initial palliation of the tetralogy of Fallot is about 16 % (70 % CL 13 %-20 %) at any age. This idea is supported by personal communication from M. Turina in Zürich, who reports a relatively recent experience with this in 24 patients with tetralogy of Fallot in the first year of life, with 3(12 %, 70 % CL 6 %-24 %) hospital deaths.We do not know from these reports whether the closed Brock procedure was used routinely or selectively. If it was used selectively, it probably was selected for patients with favorable anatomy in the right ventricular outflow tract. This makes the relatively high mortality even more impressive.Our review of the literature accumulated 903 patients with tetralogy of Fallot who underwent a palliative Brock procedure (2, 7, 8,9,11, 16, 17,18,19,22,23,26,27,28,29,31,32). 116 patients (12.8 %, 70 % CL* 11.7 %-14.1 %) died in hospital, not initially at least a strong recommendation for this procedure. The age by year of the patients at operation was given for only 165 patients, of whom 27 (16 %, 70 % CL 13 %-20 %) died in hospital (Table 1) (2,9,10, 11,17, 18, 19,23,28,29,32). We were unable to determine the risk by month in the first year of life. We do not see here a clear relation be-* Throughout this paper 70 % CL refers to 70 % confidence limits Heruntergeladen von: National University of Singapore. Urheberrechtlich geschützt.