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(Circulation. 1963;27:801.)
© 1963 American Heart Association, Inc.

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The Need for Systemic-Pulmonary Artery Shunts in the Surgical Management of Tetralogy of Fallot

PAUL D. HARRIS M.D.¹; WILLIAM F. BERNHARD M.D.¹; ROBERT E. GROSS M.D.¹; ALEXANDER S. NADAS M.D.¹

¹ From the Children's Hospital Medical Center and Harvard Medical School, Boston, Massachusetts.

When managing infants and small children with severe enough symptoms to require operative intervention, there can be no doubt that the establishment of a shunt is highly efficacious. Total repair can be contemplated some years later. If technically feasible, a shunt of the Blalock-Taussig type is the desired form of procedure. When dealing with very small infants, a Potts anastomosis has a higher probability of remaining patent and is therefore more desirable, even though it might be more difficult to obliterate at the second operation.

In older or larger children with the pink tetralogy, total correction in one stage can be advised with an acceptably low mortality rate. However, in older subjects with severe cyanosis, it is now our policy in nearly all cases to employ a two-stage attack in the form of a preliminary systemic-pulmonary arterial shunt, proceeding with complete correction some years later.