The Blalock-Hanlon operation: an anachronism?

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Neonatal Critical Care

Background:

• Dextrotransposition of the great arteries (D-TGA) often requires intervention to improve mixing of oxygenated and deoxygenated blood.
• Rashkind balloon atrial septostomy is a common initial procedure, but can be inadequate in some cases.
• Early surgical correction is an alternative, but less invasive palliative options are sought.

Purpose of the Study:

• To evaluate the efficacy and safety of Blalock-Hanlon closed atrial septectomy as an alternative to inadequate Rashkind balloon atrial septostomy in D-TGA patients.
• To assess the impact of Blalock-Hanlon septectomy on physiological parameters and subsequent outcomes.

Main Methods:

• Retrospective review of 19 patients with D-TGA who underwent Blalock-Hanlon closed atrial septectomy between 1971 and 1985.
• Analysis of patient demographics, procedural details, operative outcomes, and physiological data (PaO2, hematocrit).
• Follow-up data on subsequent definitive repair (Mustard or Rastelli procedures) and long-term outcomes.

Main Results:

• No operative deaths occurred during the Blalock-Hanlon procedure.
• Average partial pressure of arterial oxygen (PaO2) increased significantly post-procedure.
• Combined mortality with subsequent definitive repair was 5% (1 death).
• One infant experienced transient neurological symptoms due to cerebral infarctions, with no permanent deficit.

Conclusions:

• Blalock-Hanlon closed atrial septectomy is a viable and safe palliative option for infants with D-TGA and inadequate Rashkind balloon atrial septostomy.
• The procedure effectively improves oxygenation and can be performed with low mortality prior to definitive surgical repair.
• Timing of definitive repair should consider infant growth, associated anomalies, and pulmonary hypertension.