Blalock-Taussig shunt
Encyclopedia
The Blalock–Taussig shunt (also referred to as a Blalock-Thomas-Taussig shunt) is a surgical procedure to give palliation to cyanotic heart defect
s which are common causes of blue baby syndrome
. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective or palliative surgery.
One branch of the subclavian artery
or carotid artery
is separated and connected with the pulmonary artery
. The lung
receives more blood with low oxygenation
from the body. The first area of application was tetralogy of Fallot
.
The Blalock–Taussig shunt may be used as the first step in the Fontan procedure
.
. This is done to avoid the reduced diastolic blood flow in the coronary circulation
associated with the Blalock–Taussig shunt.
, surgeon, Baltimore(1899–1964), Helen B. Taussig
, cardiologist, Baltimore/Boston (1898–1986) and Vivien Thomas
(1910–1985) who was at that time Blalock's laboratory technician, developed the procedure. Taussig, who treated hundreds of infants and children with this disorder, had observed that children with a cyanotic heart defect and a patent ductus arteriosus
(PDA) lived longer than those without the PDA. It therefore seemed to her that a shunt which mimicked the function of a PDA might relieve the tetralogy patients' poor oxygenation. In 1943, having broached the possibility of a surgical solution to Dr. Robert Gross of Boston without success, Dr. Taussig approached Blalock and Thomas in their Hopkins laboratory in 1943. According to the account of the original consultation between the three provided in Vivien Thomas' 1985 autobiography Partners of the Heart, Taussig carefully described the anomaly of Tetralogy of Fallot, but made no suggestion about the specific surgical correction required, observing merely that it should be possible to get more blood to the lungs, "as a plumber changes pipes around." Although Dr. Taussig was not aware of it at that time, Blalock and Thomas had already experimented with such an anastomosis
, one that Blalock had conceived years earlier for a different purpose but which had the unanticipated effect of re-routing blood to the lungs. The operation involved the joining of the subclavian artery to the pulmonary artery. After meeting with Taussig, the two men set about perfecting the operation in the animal lab, with Thomas performing the subclavian-to-pulmonary anastomosis alone in some 200 laboratory dogs, then adapting the instruments for the first human surgery from those used on the experimental animals and coaching Blalock through the first 100 operations on infants.
Thomas' autobiographical account, corroborated by the participants in the early tetralogy operations (Drs. Denton Cooley
and the late William P. Longmire, Jr., intern and resident respectively during the surgery) has led to the recent conclusion that Thomas' contribution, both experimentally and clinically, was so critical that he should have received credit for the procedure along with Drs. Blalock and Taussig. However, because of the racial prejudices of the time, and the academic custom which generally precluded mention of non-degreed lab assistants (Thomas had no formal education beyond high school), he did not receive the honor of having the shunt named after him. The 2004 HBO television movie Something the Lord Made
, based on Washingtonian
writer Katie McCabe's 1989 article of the same name, was made about his role in the historic Blue Baby surgery, as was the 2003 public television documentary Partners of the Heart.
Cyanotic heart defect
A cyanotic heart defect is a group-type of congenital heart defects . The patient appears blue , due to deoxygenated blood bypassing the lungs and entering the systemic circulation...
s which are common causes of blue baby syndrome
Blue baby syndrome
Blue baby syndrome is a layman's term used to describe newborns with cyanotic heart lesions, such as* Persistent Truncus Arteriosus* Transposition of the great vessels* Tricuspid atresia* Tetralogy of Fallot...
. In modern surgery, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective or palliative surgery.
One branch of the subclavian artery
Subclavian artery
In human anatomy, the subclavian arteries are two major arteries of the upper thorax , below the clavicle . They receive blood from the top of the aorta...
or carotid artery
Carotid artery
Carotid artery can refer to:* Common carotid artery* External carotid artery* Internal carotid artery...
is separated and connected with the pulmonary artery
Pulmonary artery
The pulmonary arteries carry deoxygenated blood from the heart to the lungs. They are the only arteries that carry deoxygenated blood....
. The lung
Human lung
The human lungs are the organs of respiration in humans. Humans have two lungs, with the left being divided into two lobes and the right into three lobes. Together, the lungs contain approximately of airways and 300 to 500 million alveoli, having a total surface area of about in...
receives more blood with low oxygenation
Oxygenation
Oxygenation may refer to:* Oxygenation , a measurement of dissolved oxygen concentration in soil or water* Oxygenation , the process by which concentrations of oxygen increase within a tissue...
from the body. The first area of application was tetralogy of Fallot
Tetralogy of Fallot
Tetralogy of Fallot is a congenital heart defect which is classically understood to involve four anatomical abnormalities...
.
The Blalock–Taussig shunt may be used as the first step in the Fontan procedure
Fontan procedure
The Fontan procedure, or Fontan/Kreutzer procedure, is a palliative surgical procedure used in children with complex congenital heart defects. It involves diverting the venous blood from the right atrium to the pulmonary arteries without passing through the morphologic pulmonary ventricle...
.
Alternatives
The procedure is no longer in use in its original form. Now a length of artificial tubing, 3 to 4 millimeters in diameter, is sewn between either the subclavian or the carotid artery and the corresponding side branch of the pulmonary artery, thus obviating the need to cut off blood supply and making it easier to regulate the blood flow to the lungs. Some centers now use a shunt directly from the right ventricle to the pulmonary artery, a Sano shuntSano shunt
A Sano shunt is a shunt from the right ventricle to the pulmonary circulation.In contrast to a Blalock–Taussig shunt, circulation is primarily in systole.It is sometimes used as the first step in a Norwood procedure....
. This is done to avoid the reduced diastolic blood flow in the coronary circulation
Coronary circulation
Coronary circulation is the circulation of blood in the blood vessels of the heart muscle . The vessels that deliver oxygen-rich blood to the myocardium are known as coronary arteries...
associated with the Blalock–Taussig shunt.
History
The original procedure was named for Alfred BlalockAlfred Blalock
Alfred Blalock was a 20th-century American surgeon most noted for his research on the medical condition of shock and the development of the Blalock-Taussig Shunt, surgical relief of the cyanosis from Tetralogy of Fallot—known commonly as the blue baby syndrome—with Vivien Thomas and pediatric...
, surgeon, Baltimore(1899–1964), Helen B. Taussig
Helen B. Taussig
Helen Brooke Taussig was an American cardiologist, working in Baltimore and Boston, who founded the field of pediatric cardiology. Notably, she is credited with developing the concept for a procedure that would extend the lives of children born with Tetrology of Fallot...
, cardiologist, Baltimore/Boston (1898–1986) and Vivien Thomas
Vivien Thomas
Vivien Theodore Thomas was an African-American surgical technician who developed the procedures used to treat blue baby syndrome in the 1940s...
(1910–1985) who was at that time Blalock's laboratory technician, developed the procedure. Taussig, who treated hundreds of infants and children with this disorder, had observed that children with a cyanotic heart defect and a patent ductus arteriosus
Patent ductus arteriosus
Patent ductus arteriosus is a congenital disorder in the heart wherein a neonate's ductus arteriosus fails to close after birth. Early symptoms are uncommon, but in the first year of life include increased work of breathing and poor weight gain...
(PDA) lived longer than those without the PDA. It therefore seemed to her that a shunt which mimicked the function of a PDA might relieve the tetralogy patients' poor oxygenation. In 1943, having broached the possibility of a surgical solution to Dr. Robert Gross of Boston without success, Dr. Taussig approached Blalock and Thomas in their Hopkins laboratory in 1943. According to the account of the original consultation between the three provided in Vivien Thomas' 1985 autobiography Partners of the Heart, Taussig carefully described the anomaly of Tetralogy of Fallot, but made no suggestion about the specific surgical correction required, observing merely that it should be possible to get more blood to the lungs, "as a plumber changes pipes around." Although Dr. Taussig was not aware of it at that time, Blalock and Thomas had already experimented with such an anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....
, one that Blalock had conceived years earlier for a different purpose but which had the unanticipated effect of re-routing blood to the lungs. The operation involved the joining of the subclavian artery to the pulmonary artery. After meeting with Taussig, the two men set about perfecting the operation in the animal lab, with Thomas performing the subclavian-to-pulmonary anastomosis alone in some 200 laboratory dogs, then adapting the instruments for the first human surgery from those used on the experimental animals and coaching Blalock through the first 100 operations on infants.
Thomas' autobiographical account, corroborated by the participants in the early tetralogy operations (Drs. Denton Cooley
Denton Cooley
Denton Arthur Cooley is an American heart surgeon famous for performing the first implantation of a total artificial heart. Cooley is also founder and surgeon in-chief of the Texas Heart Institute, chief of Cardiovascular Surgery at St...
and the late William P. Longmire, Jr., intern and resident respectively during the surgery) has led to the recent conclusion that Thomas' contribution, both experimentally and clinically, was so critical that he should have received credit for the procedure along with Drs. Blalock and Taussig. However, because of the racial prejudices of the time, and the academic custom which generally precluded mention of non-degreed lab assistants (Thomas had no formal education beyond high school), he did not receive the honor of having the shunt named after him. The 2004 HBO television movie Something the Lord Made
Something the Lord Made
Something The Lord Made is a film about the black cardiac pioneer Vivien Thomas and his complex and volatile partnership with white surgeon Alfred Blalock, the world famous "Blue Baby doctor" who pioneered modern heart surgery...
, based on Washingtonian
Washingtonian (magazine)
Washingtonian is a monthly magazine distributed in the Washington, DC area since 1965. The magazine describes itself as "the magazine Washington lives by." The magazine's core focuses are local feature journalism, guide book-style articles, and real estate advice.-Editorial Content:Washingtonian...
writer Katie McCabe's 1989 article of the same name, was made about his role in the historic Blue Baby surgery, as was the 2003 public television documentary Partners of the Heart.