18 - No More Blue Babies: The Innovation and Evolution of the Blalock-Taussig-Thomas Shunt

Publication Number: 2015.18

Paolo I. Amar, University of Texas Southwestern Medical School, RICHARDSON, TX, United States; Jacob Edwards, University of Texas Southwestern Medical School, Rockwall, TX, United States; Munachiso V.. Mmuo, University of Texas Southwestern Medical School, Lebanon, NH, United States; Araoluwa Akinfenwa, University of Texas Southwestern Medical School, Anna, TX, United States; Ritu R. Trivedi, University of Texas Southwestern Medical School, Dallas, TX, United States; Ryan M. Mugo, University of Texas Southwestern Medical School, Anna, TX, United States; Marzuq O. Jaiyeola, University of Texas Southwestern Medical School, allen, TX, United States; Caitlyn C. Belza, Children's Health, Dallas, TX, United States; Rachel L.. Leon, University of Texas Southwestern Medical School, Dallas, TX, United States; Kikelomo Babata, UTSW, Dallas, TX, United States

Background: The Blalock-Taussig-Thomas shunt (BTT shunt) is the landmark procedure in congenital cardiac surgery that connects the subclavian artery to the pulmonary artery in infants with cyanotic congenital heart disease (CHD). The BTT shunt improves cyanosis from restricted pulmonary blood flow, a prominent feature in multiple forms of cyanotic CHD. The BTT shunt was initially developed for infants with tetralogy of Fallot (TOF) and was subsequently modified (mBTT shunt) utilizing a prosthetic graft to create a more effective and safer procedure.

Objective: To review the development, use, and evolution of the BTT shunt as a surgical palliation for cyanotic CHD.

Design/Methods: We conducted a PubMed search, reviewed historical accounts, and biographies for the history of the BTT shunt and its influence on clinical practice.

Results: In 1944, Drs. Helen Taussig and Alfred Blalock along with pioneering lab technician Vivien Thomas collaborated at John Hopkins University to develop the first operative approach for TOF. Taussig observed that infants with TOF had severe hypoxemia due to reduced pulmonary blood flow and hypothesized that surgical redirection of systemic blood flow to the pulmonary artery could improve cyanosis. With Taussig's urging, Blalock worked with Vivien Thomas in the lab on over 200 canine cyanotic CHD models to develop the BTT shunt technique. In the early 1960s, the method was modified to involve a synthetic graft which better preserved the native vasculature and circulation to the arm. The modified BTT shunt enhanced pulmonary flow and was technically less complicated and has largely replaced the classic BTT shunt. Currently, catheter-based alternative techniques such as ductus arteriosus stenting are increasingly used, the mBTT shunt continues to be a regularly performed procedure for palliation of neonates with cyanotic CHD.

Conclusion(s): The BTT shunt was an important breakthrough in the surgical management of neonates with cyanotic CHD. The procedure received international recognition, heralding the modern era of cardiovascular care in neonates. Modifications, such as the mBTT shunt, have refined the surgical procedure and improved results. The development of the BTT shunt exemplifies teamwork, dedication, and creativity. In recent years, the omission of Vivien Thomas's name from the shunt's eponym has gained prominence, with advocates calling for it to be renamed the Blalock-Taussig-Thomas shunt to accurately acknowledge the diverse collaborative innovation behind this lifesaving cardiac surgical technique.

Timeline of BTT Shunt Development
Figure 1: Graphic Displaying the Timeline of BTT Shunt Development

Primary Timeline: Thomas, Blaock & Taussig- A Collaborative History
Figure 2: Complete Timeline of the Collaborative History of the BTT Shunt