Operative Management of the Blalock-Taussig Anastomosis During Total Repair of Tetralogy of Fallot

Surgical obliteration of a subclavian-to-pulmonary artery anastomosis is necessary in the total repair of tetralogy of Fallot. However, exposure of the anastomotic site can be difficult and dangerous because of dense scarring about the anastomosis. A simple and safe method for exposure of the Blalock-Taussig anastomosis has been used over the past 12 years. Exposure and isolation of the shunt prior to cardiopulmonary bypass, temporary occlusion of it during the intracardiac repair, and ligation after complete correction was performed in 241 patients. In 152 patients, intrapericardial dissection between the superior vena cava and the ascending aorta provided exposure of the right Blalock-Taussig shunt. In 58 patients with a left Blalock-Taussig anastomosis, an extrapericardial dissection was performed, and in 22 patients both methods were employed for bilateral shunts. Nine patients required closure of a Potts anastomosis as well as a right subclavian-to-pulmonary artery anastomosis. In all patients the shunt was satisfactorily exposed and there were no major complications or deaths resulting from obliteration of these shunts. These operative methods have provided a safe and effective technique for ligation of the Blalock-Taussig anastomosis during total repair of tetralogy of Fallot.