[Radical correction of Fallot's tetralogy following an earlier Blalock-Taussig anastomosis]

Seventy-nine radical interventions for Fallot's tetralogy after a previously established Blalock-Taussig anastomosis were conducted at Bakulev Institute of Cardiovascular Surgery, AMS USSR, from 1983 to Dec. 1989. The average age at which the radical operation was undertaken was 10.1 +/- 0.4 years. The interval between the two operations ranged from 1 year to 12 years (7.0 +/- 0.2 year on average). Thrombosis of the anastomosis occurred in 2 (2.5%) patients. Development of pulmonary hypertension was not encountered. Complications like "functional atresia" of the right-ventricular outflow tract (5.1%) and acquired atresia of the valve of the pulmonary trunk (2.5%) were encountered when the interval between the two operations was more than 7 years, and developed mostly in patients with the anastomosis formed before the age of 2 years. In 70 (88.6%) patients the subclavian artery was ligated, in 6 the opening of the anastomosis was sutured through the lumen of the respective pulmonary trunk. Surgically significant constrictions of the branches of the pulmonary arteries were revealed in 10 (12.6%) patients, which called for plastic distension during radical correction. In 7 (8.8%) patients the operative interventions were limited to infundibulectomy. Transannular plastics was necessary in more than half of the patients (55.7%). A conduit containing a xenovalve was implanted between the right ventricle and the pulmonary trunk in one (1.3%) patients. Hospital mortality was 6.3% (5 patients died). With a proper surgical approach, complications of the Blalock-Taussig anastomosis produce no essential effect on the results of radical correction, which may be carried out with a mild degree of risk and a low mortality rate.