Summary
The surgical problems in total correction of tetralogy of Fallot following palliation
encountered in 65 patients after construction of Waterston-Cooley (33) and Blalock-Taussig (32) anastomoses are presented. The Waterston-Cooley shunt was severely angulated
in 9 patients, causing underperfusion or occlusion of the left pulmonary artery. Pulmonary
hypertension was present in 3 patients with increased vascular resistance in one.
The Blalock-Taussig anastomosis was obliterated in 9 patients, caused complete occlusion
of the right pulmonary artery in one and formation of an aneurysm of the subclavian
artery at the site of the anastomosis in one. Transannular patching of the right ventricular
outflow tract was necessary in 95 % of the patients palliated in the first year of
life. As some degree of angulation of the Waterston-Cooley anastomosis was seen in
almost 60% of the patients, we have abandoned its transaortic closure technique. The
right pulmonary artery is now dissected from the aorta and both the aorta and pulmonary
artery are sutured separately. The operative mortality rate was 16.9 % and is markedly
higher than in our non-palliated patients undergoing correction of tetralogy of Fallot.
Two early and one late death must be attributed to the previous shunt procedure.
With regard to the high incidence of complications and failures of the aortopulmonary
shunts, we conclude that their application should be restricted to symptomatic babies
with a hypoplastic pulmonary valve and annulus requiring early surgical intervention
because of severe hypoxemia.
Key words
Tetralogy of Fallot - Staged repair - Complications of Waterston-Cooley anastomosis
- Complications of Blalock-Taussig anastomosis
