Ten to Thirteen Year Follow-up on Patients after a Blalock-Taussig Operation

Abstract

Analysis of 224 patients who were living 5 years after operation showed that at the end of 10 to 13 years, 40 per cent were still doing well, 46 per cent had failed to maintain improvement, 2 per cent had developed cardiac failure, and 12 per cent had died. The majority of patients who had failed to maintain improvement suffered from increasing cyanosis and dyspnea associated with a small heart and clear lung fields; hence these patients can be helped by a second operation:— either a second anastomosis or total correction. The results of a second anastomosis have, however, not been as satisfactory as the first anastomosis. Clearly total correction is the ideal. The age at which total correction is indicated depends not only on the skill of the surgeon but on the severity of the abnormality. The long-time results of total correction are unknown. Inasmuch as abnormal tissue does not grow as fast as normal tissue, the possibility exists that the area in which tissue has been excised and a patch inserted may fail to grow or even contract and cause the right ventricle to become abnormally small. Analysis of the results at the end of 5, 10, and 13 years showed that only 10 patients (less than 5 per cent) had required a second operation at the end of a years and only 20 per cent had required a second operation in the ensuing 5 years. Older patients, i.e., those between 8 and 12 years, had done far better than younger children. Only two of a group of 38 children operated upon between 8 and 12 years of age had required a second operation within 10 years. Thus a Blalock-Taussig operation offers the child an excellent chance to attain the major part of his growth before total correction is undertaken. A further advantage of an early anastomotic procedure is that it restores the pulmonary vascular bed to normal and thereby renders it easier for the lungs to adjust to the full circulatory load placed on them at the time of the total correction. The conclusion is reached, therefore, that for infants and small children a Blalock-Taussig operation is preferable. For children who have attained or nearly attained full growth, total correction is the ideal. For many patients, especially those between 8 and 12 years of age for whom total correction is not possible, a simple Blalock-Taussig operation offers an extremely good prognosis.