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Tetralogy of Fallot: Postsurgical and Palliation, BT Shunt
Suhny Abbara, MD, FACR, FSCCT; Cameron Hassani, MD; Arzu Canan, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Clinical Issues

        • Diagnostic Checklist

          TERMINOLOGY

          • Abbreviations

            • Tetralogy of Fallot (TOF)
            • Blalock-Taussig (BT)
          • Synonyms

            • Blalock-Taussig shunt, Blalock-Taussig procedure, "blue baby" operation
          • Definitions

            • Definitive repair: Closure of ventricular septal defect (VSD) and repair of right ventricular outflow tract (RVOT) obstruction
              • Pulmonary valvotomy for mild RVOT obstruction
              • Placement of transannular patch ± division/resection of obstructing muscle bundles
              • Placement of graft conduit between right ventricle (RV) and pulmonary artery (PA) if anomalous coronary artery prevents access to RV infundibulum or complete pulmonary valve (PV) atresia
            • Previous palliative shunts are usually taken down
            • Palliative procedure to increase pulmonary blood flow
            • Original BT shunt sacrifices subclavian artery (distal ligation)
              • First performed in November 1944 at Johns Hopkins University Hospital
              • Proximal portion of subclavian artery routed inferiorly to end-to-side anastomosis with ipsilateral branch PA
              • Alfred Blalock (1899-1964)
                • 1st surgeon to perform procedure
              • Helen Taussig (1898-1986)
                • Pediatric cardiologist who designed shunt
            • Modified BT shunt uses synthetic graft, usually polytetrafluoroethylene (Gore-Tex)
              • Proximal anastomosis is end-to-side between graft (end) and subclavian artery or brachiocephalic trunk (side)
              • Distal anastomosis is end-to-side between distal graft (end) and ipsilateral PA (side)
            • Ductus arteriosus stenting
            • Waterson-Cooley shunt: Ascending aorta to right PA
            • Potts shunt: Descending aorta to left PA (no longer performed)

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      DIFFERENTIAL DIAGNOSIS

                        CLINICAL ISSUES

                        • Presentation

                          • Natural History & Prognosis

                            • Treatment

                              DIAGNOSTIC CHECKLIST

                              • Consider

                                • Reporting Tips

                                  Selected References

                                  1. Ranganath P et al: Computed tomography in adult congenital heart disease. Radiol Clin North Am. 57(1):85-111, 2019
                                  2. Mercer-Rosa L et al: Perioperative factors influence the long-term outcomes of children and adolescents with repaired tetralogy of Fallot. Pediatr Cardiol. ePub, 2018
                                  3. Stout KK et al: 2018 AHA/ACC guideline for the management of adults With congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. ePub, 2018
                                  4. Vaujois L et al: Imaging of postoperative tetralogy of Fallot repair. Diagn Interv Imaging. 97(5):549-60, 2016
                                  5. Downing TE et al: Tetralogy of Fallot: General principles of management. Cardiol Clin. 33(4):531-41, vii-viii, 2015
                                  6. Ahmed S et al: Role of multidetector CT in assessment of repaired tetralogy of Fallot. Radiographics. 33(4):1023-36, 2013
                                  7. Ordovas KG et al: Cardiovascular MR imaging after surgical correction of tetralogy of Fallot: approach based on understanding of surgical procedures. Radiographics. 33(4):1037-52, 2013
                                  8. Moszura T et al: Late emergency arterial duct stenting in a patient with tetralogy of Fallot and occluded Blalock-Taussig shunt. Cardiol J. 18(1):87-9, 2011
                                  9. Kim SW et al: Tetralogy of fallot patient who underwent a classic Blalock-Taussig shunt in 1962. J Card Surg. 25(6):745-6, 2010
                                  10. Yuan SM et al: The Blalock-Taussig shunt. J Card Surg. 24(2):101-8, 2009
                                  11. Peries A et al: Outcome of the construction of a Blalock-Taussig shunt in adolescents and adults. Cardiol Young. 15(4):368-72, 2005
                                  12. Maghur HA et al: The modified Blalock-Taussig shunt: a 6-year experience from a developing country. Pediatr Cardiol. 23(1):49-52, 2002
                                  13. Quek SC et al: Thrombotic obstruction of modified Blalock-Taussig shunt. Cardiol Young. 12(4):391, 2002
                                  14. Rana JS et al: Blalock-Taussig shunt: experience from the developing world. Heart Lung Circ. 11(3):152-6, 2002
                                  15. 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
                                  16. Coren ME et al: Complications of modified Blalock-Taussig shunts mimicking pulmonary disease. Arch Dis Child. 79(4):361-2, 1998
                                  17. Hofbeck M et al: Color Doppler imaging of modified Blalock-Taussig shunts during infancy. Pediatr Cardiol. 15(6):163-6, 1994
                                  18. Ichida F et al: [Magnetic resonance imaging: evaluation of the Blalock-Taussig shunts and anatomy of the pulmonary artery] J Cardiol. 22(4):669-78, 1992
                                  19. Kastler B et al: Magnetic resonance imaging in congenital heart disease of newborns: preliminary results in 23 patients. Eur J Radiol. 10(2):109-17, 1990
                                  20. Ullom RL et al: The Blalock-Taussig shunt in infants: standard versus modified. Ann Thorac Surg. 44(5):539-43, 1987
                                  21. Sakuma I et al: [An application of X-ray computed tomography for complex cardiac anomalies] J Cardiogr. 13(3):699-713, 1983
                                  22. Blalock A et al: The surgical treatment of malformation of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA. 128(3):189-202, 1945
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Clinical Issues

                                        • Diagnostic Checklist

                                          TERMINOLOGY

                                          • Abbreviations

                                            • Tetralogy of Fallot (TOF)
                                            • Blalock-Taussig (BT)
                                          • Synonyms

                                            • Blalock-Taussig shunt, Blalock-Taussig procedure, "blue baby" operation
                                          • Definitions

                                            • Definitive repair: Closure of ventricular septal defect (VSD) and repair of right ventricular outflow tract (RVOT) obstruction
                                              • Pulmonary valvotomy for mild RVOT obstruction
                                              • Placement of transannular patch ± division/resection of obstructing muscle bundles
                                              • Placement of graft conduit between right ventricle (RV) and pulmonary artery (PA) if anomalous coronary artery prevents access to RV infundibulum or complete pulmonary valve (PV) atresia
                                            • Previous palliative shunts are usually taken down
                                            • Palliative procedure to increase pulmonary blood flow
                                            • Original BT shunt sacrifices subclavian artery (distal ligation)
                                              • First performed in November 1944 at Johns Hopkins University Hospital
                                              • Proximal portion of subclavian artery routed inferiorly to end-to-side anastomosis with ipsilateral branch PA
                                              • Alfred Blalock (1899-1964)
                                                • 1st surgeon to perform procedure
                                              • Helen Taussig (1898-1986)
                                                • Pediatric cardiologist who designed shunt
                                            • Modified BT shunt uses synthetic graft, usually polytetrafluoroethylene (Gore-Tex)
                                              • Proximal anastomosis is end-to-side between graft (end) and subclavian artery or brachiocephalic trunk (side)
                                              • Distal anastomosis is end-to-side between distal graft (end) and ipsilateral PA (side)
                                            • Ductus arteriosus stenting
                                            • Waterson-Cooley shunt: Ascending aorta to right PA
                                            • Potts shunt: Descending aorta to left PA (no longer performed)

                                          IMAGING

                                          • General Features

                                            • Radiographic Findings

                                              • CT Findings

                                                • MR Findings

                                                  • Echocardiographic Findings

                                                    • Angiographic Findings

                                                      DIFFERENTIAL DIAGNOSIS

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              DIAGNOSTIC CHECKLIST

                                                              • Consider

                                                                • Reporting Tips

                                                                  Selected References

                                                                  1. Ranganath P et al: Computed tomography in adult congenital heart disease. Radiol Clin North Am. 57(1):85-111, 2019
                                                                  2. Mercer-Rosa L et al: Perioperative factors influence the long-term outcomes of children and adolescents with repaired tetralogy of Fallot. Pediatr Cardiol. ePub, 2018
                                                                  3. Stout KK et al: 2018 AHA/ACC guideline for the management of adults With congenital heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. ePub, 2018
                                                                  4. Vaujois L et al: Imaging of postoperative tetralogy of Fallot repair. Diagn Interv Imaging. 97(5):549-60, 2016
                                                                  5. Downing TE et al: Tetralogy of Fallot: General principles of management. Cardiol Clin. 33(4):531-41, vii-viii, 2015
                                                                  6. Ahmed S et al: Role of multidetector CT in assessment of repaired tetralogy of Fallot. Radiographics. 33(4):1023-36, 2013
                                                                  7. Ordovas KG et al: Cardiovascular MR imaging after surgical correction of tetralogy of Fallot: approach based on understanding of surgical procedures. Radiographics. 33(4):1037-52, 2013
                                                                  8. Moszura T et al: Late emergency arterial duct stenting in a patient with tetralogy of Fallot and occluded Blalock-Taussig shunt. Cardiol J. 18(1):87-9, 2011
                                                                  9. Kim SW et al: Tetralogy of fallot patient who underwent a classic Blalock-Taussig shunt in 1962. J Card Surg. 25(6):745-6, 2010
                                                                  10. Yuan SM et al: The Blalock-Taussig shunt. J Card Surg. 24(2):101-8, 2009
                                                                  11. Peries A et al: Outcome of the construction of a Blalock-Taussig shunt in adolescents and adults. Cardiol Young. 15(4):368-72, 2005
                                                                  12. Maghur HA et al: The modified Blalock-Taussig shunt: a 6-year experience from a developing country. Pediatr Cardiol. 23(1):49-52, 2002
                                                                  13. Quek SC et al: Thrombotic obstruction of modified Blalock-Taussig shunt. Cardiol Young. 12(4):391, 2002
                                                                  14. Rana JS et al: Blalock-Taussig shunt: experience from the developing world. Heart Lung Circ. 11(3):152-6, 2002
                                                                  15. 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
                                                                  16. Coren ME et al: Complications of modified Blalock-Taussig shunts mimicking pulmonary disease. Arch Dis Child. 79(4):361-2, 1998
                                                                  17. Hofbeck M et al: Color Doppler imaging of modified Blalock-Taussig shunts during infancy. Pediatr Cardiol. 15(6):163-6, 1994
                                                                  18. Ichida F et al: [Magnetic resonance imaging: evaluation of the Blalock-Taussig shunts and anatomy of the pulmonary artery] J Cardiol. 22(4):669-78, 1992
                                                                  19. Kastler B et al: Magnetic resonance imaging in congenital heart disease of newborns: preliminary results in 23 patients. Eur J Radiol. 10(2):109-17, 1990
                                                                  20. Ullom RL et al: The Blalock-Taussig shunt in infants: standard versus modified. Ann Thorac Surg. 44(5):539-43, 1987
                                                                  21. Sakuma I et al: [An application of X-ray computed tomography for complex cardiac anomalies] J Cardiogr. 13(3):699-713, 1983
                                                                  22. Blalock A et al: The surgical treatment of malformation of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA. 128(3):189-202, 1945