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{{Short description|Cardiac surgery procedure}} |
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{{more footnotes|date=July 2013}} |
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{{no footnotes|date=August 2020}} |
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{{Infobox interventions |
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{{Infobox medical intervention (new) |
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| Name = Blalock–Thomas–Taussig shunt |
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| Image = Gray505.png |
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| name = Blalock–Taussig shunt |
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| synonyms = Blalock–Taussig shunt, BTT shunt |
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| Caption = The arch of the aorta and its branches. In the Blalock–Thomas–Taussig shunt, blood from the ] or ] (in red at the top) is redirected to the ] (in blue near the center). |
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| image = Blalock Taussig Shunt - Aortic to Pulmonary.png |
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| ICD10 = |
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| caption = Modified Blalock–Thomas–Taussig Shunt connecting right subclavian artery to pulmonary artery |
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| ICD9 = {{ICD9proc|39.0}} |
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| MeshID = D058366 |
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| specialty = ] |
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| uses = ], ] |
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| complications = ], ] injury, ], shunt stenosis, ] |
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| approach = ] or ] |
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| types = Classical, modified |
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The '''Blalock–Thomas–Taussig shunt''' (commonly called the '''Blalock–Taussig shunt''') is a surgical procedure used to increase pulmonary blood flow for palliation in duct dependent ]s like pulmonary atresia, which are common causes of ]. 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 definitive surgery. |
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The '''Blalock–Thomas–Taussig shunt''' ('''BTT shunt'''),<ref>{{Cite journal |last1=Blake |first1=Kathleen |last2=Yancy |first2=Clyde W. |date=2022-04-01 |title=Change the Name of the Blalock–Taussig Shunt to Blalock–Thomas–Taussig Shunt |url=https://doi.org/10.1001/jamasurg.2021.5611 |journal=JAMA Surgery |volume=157 |issue=4 |pages=287–288 |doi=10.1001/jamasurg.2021.5611 |pmid=34964811 |s2cid=245538449 |issn=2168-6254}}</ref> previously known as the '''Blalock–Taussig Shunt''' ('''BT shunt'''),<ref name="mBTT">{{Cite journal |last1=Alahmadi |first1=Mohamed H. |last2=Bishop |first2=Michael A. |date=2023-10-14 |title=Modified Blalock-Taussig-Thomas Shunt |url=https://www.ncbi.nlm.nih.gov/books/NBK597363/ |journal=StatPearls |pmid=37983362}}</ref> is a surgical procedure used to increase blood flow to the lungs in some forms of ]<ref name=":1">{{Cite journal|last1=Yuan|first1=Shi-Min|last2=Shinfeld|first2=Amihay|last3=Raanani|first3=Ehud|date=March 2009|title=The Blalock–Taussig shunt|journal=Journal of Cardiac Surgery|volume=24|issue=2|pages=101–108|doi=10.1111/j.1540-8191.2008.00758.x|issn=1540-8191|pmid=19040408|doi-access=free}}</ref> such as ] and ], which are common causes of ].<ref name=":1" /> The procedure involves connecting a branch of the ] or ] to the ]. In modern practice, this procedure is temporarily used to direct blood flow to the lungs and relieve cyanosis while the infant is waiting for corrective or definitive surgery when their heart is larger. The BTT shunt is used in the first step of the three-stage palliation (the ]). |
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One branch of the ] or ] is separated and connected with the ]. The first area of application was ]. |
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The Blalock–Thomas-Taussig shunt is used in the first step of the three stage palliation (]). |
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==Alternatives== |
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==Alternatives== |
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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 ]. This is done to avoid the reduced diastolic blood flow in the ] associated with the Blalock-Thomas-Taussig shunt. |
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While the originally described Blalock–Thomas–Taussig shunt directly connected the subclavian and pulmonary arteries, in contemporary practice a modified version of the procedure, the mBTT shunt, is more commonly used.<ref name="mBTT" /><ref name=":0">{{Cite journal|last1=Kiran|first1=Usha|last2=Aggarwal|first2=Shivani|last3=Choudhary|first3=Arin|last4=Uma|first4=B.|last5=Kapoor|first5=Poonam Malhotra|date=July 2017|title=The Blalock and Taussig Shunt Revisited|journal=Annals of Cardiac Anaesthesia|volume=20|issue=3|pages=323–330|doi=10.4103/aca.ACA_80_17|issn=0974-5181|pmc=5535574|pmid=28701598 |doi-access=free }}</ref> In the modified Blalock–Thomas–Taussig shunt, a length of artificial tubing typically made from ] (]) is sewn between either the subclavian or the carotid artery and the corresponding side branch of the pulmonary artery.<ref name=":0" /> This modification removes the need to cut off blood supply and makes 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 ]. This is done to avoid the reduced diastolic blood flow in the ] associated with the mBTT shunt.{{citation needed|date=June 2020}} |
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==History== |
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==History== |
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The original procedure was named for ], surgeon, Baltimore (1899–1964), ], cardiologist, Baltimore/Boston (1898–1986) and ] (1910–1985) who was at that time Blalock's laboratory technician. They all helped to develop the procedure. Taussig, who treated hundreds of infants and children with this disorder, had observed that children with a cyanotic heart defect and a ] (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 Robert Gross of Boston without success, 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 Taussig was not aware of it at that time, Blalock and Thomas had already experimented with such an ], 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. |
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The original procedure was named for ], surgeon, Culloden, GA (1899–1964), ], cardiologist, Baltimore/Boston (1898–1986) and ] (1910–1985) who was at that time Blalock's laboratory assistant. They all helped to develop the procedure. Taussig, who treated hundreds of infants and children with this disorder, had observed that children with a cyanotic heart defect and a ] (PDA) lived longer than those without the PDA. It, therefore, seemed to her that a shunt that mimicked the function of a PDA might relieve the tetralogy patients' poor oxygenation. In 1943, having broached the possibility of a surgical solution to ] of Boston without success, 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 Taussig was not aware of it at that time, Blalock and Thomas had already experimented with such an ], 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.{{cn|date=February 2021}} |
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Thomas' autobiographical account, corroborated by the participants in the early tetralogy operations (] 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 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 '']'', based on '']'' 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.'' |
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Thomas' autobiographical account, corroborated by the participants in the early tetralogy operations (] 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 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 '']'', based on '']'' 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.''{{cn|date=February 2021}} |
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<gallery> |
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<gallery> |
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File:Blalock Taussig Shunt - Aortic to Pulmonary.png|Blalock Taussig Shunt - Right Subclavian artery to right pulmonary artery. |
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File:Blalock Taussig Shunt - Subclavian to Pulmonary.png|Blalock–Thomas-Taussig Shunt – left subclavian artery to left pulmonary artery. |
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File:Blalock Taussig Shunt - Subclavian to Pulmonary.png|Blalock Taussig Shunt - Left subclavian artery to left pulmonary artery. |
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</gallery> |
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</gallery> |
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==References== |
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==References== |
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{{reflist}} |
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{{reflist}} |
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* ''Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock'', by Vivien T. Thomas (originally published as ''Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and His Work with Alfred Blalock''), University of Pennsylvania Press, 1985. {{ISBN|0-8122-1634-2}} |
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:* ''Partners of the Heart: Vivien Thomas and His Work with Alfred Blalock'', by Vivien T. Thomas (originally published as ''Pioneering Research in Surgical Shock and Cardiovascular Surgery: Vivien Thomas and His Work with Alfred Blalock''), University of Pennsylvania Press, 1985. {{ISBN|0-8122-1634-2}} |
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{{Cardiac surgery procedures}} |
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{{Cardiac surgery procedures}} |
While the originally described Blalock–Thomas–Taussig shunt directly connected the subclavian and pulmonary arteries, in contemporary practice a modified version of the procedure, the mBTT shunt, is more commonly used. In the modified Blalock–Thomas–Taussig shunt, a length of artificial tubing typically made from PTFE (Gore-tex) is sewn between either the subclavian or the carotid artery and the corresponding side branch of the pulmonary artery. This modification removes the need to cut off blood supply and makes 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 shunt. This is done to avoid the reduced diastolic blood flow in the coronary circulation associated with the mBTT shunt.
Thomas' autobiographical account, corroborated by the participants in the early tetralogy operations (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 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.
Modified Blalock–Thomas–Taussig Shunt connecting right subclavian artery to pulmonary artery
Blalock–Thomas-Taussig Shunt – left subclavian artery to left pulmonary artery.
