Although corrective surgery for patients with tetralogy of Fallot is now available and popular with the advent of open heart techniques, systemic-pulmonary arterial shunting procedures are still helpful in certain circumstances; in small, deeply cyanotic infants and older children, for palliation and as an initial procedure, in whom open correction may be associated with a poor risk.
Since Blalock and Taussig achieved subclavian-pulmonary arterial anastomosis in 1945, many modifications of systemic-pulmonary arterial anastomosis were reported by many attributors, of which Blalock and Potts anastomoses have been popular. Recently, increased attention has been given also to the use of intrapericardial ascending aortic-right pulmonary arterial anastomosis in infants.
During the period of April, 1962, to March 1968, the authors exprienced several palliative surgical procedures in 64 patients with tetralogy of Fallot or other similar congenital cardiac malformations accompanied with pulmonary stanosis, and this report deals with 59 cases undertaken systemic-pulmonary arterial anastomoses on preoperative clinical findings, operative procedures and its results.
1. Among 59 cases, 56 cases were tetralogy of Fallot, and the remainings were 2 cases of so-called pentalogy and one case of bilocular heart with pulmonary valvular stenosis.
2. 36 cases of 59 were male, 40 cases were under 10 years of age and no cases were encountered under 2 years of age.
3. Diagnosis was confirmed by angiocardiography and right heart catheterization Types of pulmonary stenosis ascertained by angiocardiography in 52 cases were 30 of infundibular stenosis, 14 of valvular stenosis and 8 of combined infundibular and valvular stenosis. And contrast filling of the aorta was gained within 2 seconds after contrast filling of the main pulmonary artery in all cases.
4. Accompanied anomaly was mainly of cardiovascular system such as 6 cases of persistent left superior vena cava and 2 of dextrocardia with situs inversus. There were also 2 cases of active pulmonary tuberculosis in this series.
5. Operative procedures were Blalock anastomosis, Potts anastomosis and intrapericardial aortic-right pulmonary arterial anastomosis in 32 cases, 8 cases and 17 cases, respectively. Other 2 cases were undergone only thoracotomy without shungins procedures because of unexpected serious complications during operation.
6. Operative mortality was 13.6 per cent, and causes of death were 4 of respiratory complications, 2 of massive hemorrhage, one of congestive heart failure and one of cardiac arrest.
7. 6 months to 6 years follow up was made in 30 cases of whom 80 per cent showed good results of shunting procedures with reduction of polycythemia, but there were no sighifcant changes of hemoglobin and hematocrit values butween 2 weeks and 5 months after operation.
8. With our experiences, the authors prefer to perform Blalock anastomosis in the majority of cases, and intrapericardial aortic-pulmonary arterial anastomosis in infants and other small group of patients who have some technical problems to perform Blalock anastomosis.
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