The development of elevated pulmonary vascular resistance in man following increased pulmonary blood flow from systemic-pulmonary anastomoses

McGaff, Charles J.; Ross, Richard S.; Braunwald, Eugene

doi:10.1016/0002-9343(62)90018-9

Cited by 29 publications

(4 citation statements)

References 14 publications

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“…Since it was clinically not possible to detect minor degrees of pulmonary arterial hypertension, the incidence of this complication in this series cannot be assessed. Nor is it possible to determine the overall incidence from other reported series, since these have usually been concerned with selected patients with pulmonary hypertension (Leeds, 1958;Ross et al, 1958;Epstein and Naji, 1960;McGaff et al, 1962).…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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

Harris¹,

Segel²,

Bishop³

1964

Heart

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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...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

Harris¹,

Segel²,

Bishop³

1964

Heart

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“…The majority of complications after establishment of aortopulmonary shunt are due to increased pulmonary blood flow leading to pulmonary oedema, congestive cardiac failure, pulmonary hypertension, development of pulmonary vascular resistance, and blood vessel disease (Ross et al, 1958;McGaff et al, 1962;Kaplan et al, 1968;Bernuth et al, 1971;Cole et al, 1971;Selmonsky et al, 1972). The flow through an aortopulmonary shunt and its effects depend on the size of the shunt and the time it has been present.…”

Section: Discussionmentioning

confidence: 99%

An evaluation of Potts' aortopulmonary shunt for palliation of cyanotic heart disease.

Daniel¹,

Clarke²,

Richardson³

et al. 1976

Thorax

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“…The subclavian artery to pulmonary artery anastomosis carries a much lower risk of pulmonary hypertension than a direct anastomosis between aorta and pulmonary artery. The reason for this complication is an excessively large pulmonary blood flow (Paul, Miller, and Potts, 1961 ;McGaff, Ross, and Braunwald, 1962;Cole, Muster, Fixler, and Paul, 1971), and a practical consequence is that the timing of corrective surgery may become a matter of urgency when the anastomosis is between these major arteries (Bernuth et al, 1971). Campbell (1972) estimated that the average life span in Fallot's tetralogy without operation was 15 years.…”

Section: Discussionmentioning

confidence: 99%

Blalock-Taussig anastomosis in 126 patients with Fallot's tetralogy

Reid¹,

Coleman²,

Barclay³

et al. 1973

Thorax

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The long-term results of Blalock anastomosis in 126 patients for Fallot's tetralogy are presented. The operative mortality was 10% and the overall mortality 38%. The 78 survivors were reviewed after periods of surveillance ranging from six months to 17 years. Complications were few.It is concluded that although total correction as a primary procedure has become the treatment of choice in most, it may in some instances never be technically feasible because of extreme underdevelopment of the right ventricular outflow tract. In the very young with urgent symptoms and rapid deterioration total correction would be considered hazardous. In the infant a high operative mortality reflected the inadequate calibre of the vessels used in the shunt operation.Blalock and Taussig (1945) introduced the first effective palliative procedure for the relief of Fallot's tetralogy by anastomosing the right subclavian artery to the corresponding pulmonary artery. Subsequent palliative operations have either anastomosed the aorta to a pulmonary artery (Potts, Smith, and Gibson, 1946;Waterston, 1962) or aimed to relieve the right ventricular outflow tract obstruction (Brock, 1948(Brock, , 1952.During 17 years we have employed almost exclusively the Blalock-Taussig anastomosis for all patients over the age of 1 year with Fallot's tetralogy demanding urgent surgical intervention because of increasing disability. We present an assessment of the results of operation and of the subsequent progress of these patients.

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The development of elevated pulmonary vascular resistance in man following increased pulmonary blood flow from systemic-pulmonary anastomoses

Cited by 29 publications

References 14 publications

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

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

An evaluation of Potts' aortopulmonary shunt for palliation of cyanotic heart disease.

Blalock-Taussig anastomosis in 126 patients with Fallot's tetralogy

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