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Cardiac
Surgical Procedures for Congenital Heart Disease
Blalock-Taussig Shunt
Blalock-Taussig Shunt
Randy R. Richardson, MD; Prakash M. Masand, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        TERMINOLOGY

        • Abbreviations

          • Blalock-Taussig (BT) shunt

        • Definitions

          • Palliative procedure to augment pulmonary blood flow in various uni- & biventricular anatomies: Tetralogy of Fallot, tricuspid atresia, pulmonary atresia, & hypoplastic left heart syndrome (part of Norwood stage 1)
            • Original/classic BT shunt
              • Developed in 1945 by Dr. Alfred Blalock, Dr. Helen Taussig, & Vivien Theodore Thomas
              • Ligation & division of right subclavian artery with end-to-side anastomosis of proximal right subclavian artery to right pulmonary artery
              • Complications included shunt thrombosis, overshunting, nerve injury, & potential growth disturbance of ipsilateral upper extremity
              • Rarely performed today
            • Modified BT shunt
              • Synthetic graft prosthesis (Gore-Tex) between subclavian artery & ipsilateral pulmonary artery, contralateral to side of aortic arch
              • End-to-side anastomosis at each connection is performed through median sternotomy or lateral thoracotomy (with former preferred)
              • Preserves blood flow to ipsilateral upper extremity
              • More easily placed on side contralateral to aortic arch
              • Up to 90% patency rate at 2 years of age

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Echocardiographic Findings

                  • Angiographic Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        Selected References

                        1. Li D et al: Modified Blalock-Taussig shunt: a single-center experience and follow-up. Heart Surg Forum. 23(1):E053-7, 2020
                        2. Peña-Trujillo V et al: Mediastinal mass after a Blalock-Taussig shunt: utility of CT angiography. Cardiol Young. 30(5):722-3, 2020
                        3. Bentham JR et al: Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation. 137(6):581-8, 2018
                        4. Glatz AC et al: Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the Congenital Catheterization Research Collaborative. Circulation. 137(6):589-601, 2018
                        5. Sasikumar N et al: Outcomes of Blalock-Taussig shunts in current era: a single center experience. Congenit Heart Dis. 12(6):808-14, 2017
                        6. Dirks V et al: Modified Blalock Taussig shunt: a not-so-simple palliative procedure. Eur J Cardiothorac Surg. 44(6):1096-102, 2013
                        7. McKenzie ED et al: The Blalock-Taussig shunt revisited: a contemporary experience. J Am Coll Surg. 216(4):699-704; discussion 704-6, 2013
                        8. Shauq A et al: Surgical approaches to the blalock shunt: does the approach matter? Heart Lung Circ. 19(8):460-4, 2010
                        9. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                        10. Williams JA et al: Two thousand Blalock-Taussig shunts: a six-decade experience. Ann Thorac Surg. 84(6):2070-5; discussion 2070-5, 2007
                        11. van Rijn RR et al: Development of a perigraft seroma around modified Blalock-Taussig shunts: imaging evaluation. AJR Am J Roentgenol. 178(3):629-33, 2002
                        12. Yoshimura N et al: Classic Blalock-Taussig shunt in neonates. J Cardiovasc Surg (Torino). 40(1):107-10, 1999
                        Related Anatomy
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                        Related Differential Diagnoses
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                        References
                        Tables

                        Tables

                        KEY FACTS

                        • Terminology

                          • Imaging

                            • Top Differential Diagnoses

                              TERMINOLOGY

                              • Abbreviations

                                • Blalock-Taussig (BT) shunt

                              • Definitions

                                • Palliative procedure to augment pulmonary blood flow in various uni- & biventricular anatomies: Tetralogy of Fallot, tricuspid atresia, pulmonary atresia, & hypoplastic left heart syndrome (part of Norwood stage 1)
                                  • Original/classic BT shunt
                                    • Developed in 1945 by Dr. Alfred Blalock, Dr. Helen Taussig, & Vivien Theodore Thomas
                                    • Ligation & division of right subclavian artery with end-to-side anastomosis of proximal right subclavian artery to right pulmonary artery
                                    • Complications included shunt thrombosis, overshunting, nerve injury, & potential growth disturbance of ipsilateral upper extremity
                                    • Rarely performed today
                                  • Modified BT shunt
                                    • Synthetic graft prosthesis (Gore-Tex) between subclavian artery & ipsilateral pulmonary artery, contralateral to side of aortic arch
                                    • End-to-side anastomosis at each connection is performed through median sternotomy or lateral thoracotomy (with former preferred)
                                    • Preserves blood flow to ipsilateral upper extremity
                                    • More easily placed on side contralateral to aortic arch
                                    • Up to 90% patency rate at 2 years of age

                              IMAGING

                              • General Features

                                • Radiographic Findings

                                  • CT Findings

                                    • MR Findings

                                      • Echocardiographic Findings

                                        • Angiographic Findings

                                          • Imaging Recommendations

                                            DIFFERENTIAL DIAGNOSIS

                                              Selected References

                                              1. Li D et al: Modified Blalock-Taussig shunt: a single-center experience and follow-up. Heart Surg Forum. 23(1):E053-7, 2020
                                              2. Peña-Trujillo V et al: Mediastinal mass after a Blalock-Taussig shunt: utility of CT angiography. Cardiol Young. 30(5):722-3, 2020
                                              3. Bentham JR et al: Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation. 137(6):581-8, 2018
                                              4. Glatz AC et al: Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the Congenital Catheterization Research Collaborative. Circulation. 137(6):589-601, 2018
                                              5. Sasikumar N et al: Outcomes of Blalock-Taussig shunts in current era: a single center experience. Congenit Heart Dis. 12(6):808-14, 2017
                                              6. Dirks V et al: Modified Blalock Taussig shunt: a not-so-simple palliative procedure. Eur J Cardiothorac Surg. 44(6):1096-102, 2013
                                              7. McKenzie ED et al: The Blalock-Taussig shunt revisited: a contemporary experience. J Am Coll Surg. 216(4):699-704; discussion 704-6, 2013
                                              8. Shauq A et al: Surgical approaches to the blalock shunt: does the approach matter? Heart Lung Circ. 19(8):460-4, 2010
                                              9. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                                              10. Williams JA et al: Two thousand Blalock-Taussig shunts: a six-decade experience. Ann Thorac Surg. 84(6):2070-5; discussion 2070-5, 2007
                                              11. van Rijn RR et al: Development of a perigraft seroma around modified Blalock-Taussig shunts: imaging evaluation. AJR Am J Roentgenol. 178(3):629-33, 2002
                                              12. Yoshimura N et al: Classic Blalock-Taussig shunt in neonates. J Cardiovasc Surg (Torino). 40(1):107-10, 1999