Five-year postoperative results of first 500 patients with Blalock-Taussig anastomosis for pulmonary stenosis or atresia.

The evaluation of surgical corrective procedures depends to an important degree on the long-term benefits derived from the operation. Three hundred and eighty-nine of the first 500 patients with a Blalock-Taussig anastomosis for pulmonary stenosis or atresia survived 6 months or longer. Detailed information is nowe available on 244 of these patients, who were originally improved by operation and who have been followed for a5 years or longer. The results obtained on patients with tetralogy of Fallot are compared with those with other malformations. The alteration of the size of the heart over a period of years has been studied. A comparison between the preoperative and postoperative hemograms and arterial oxygen saturations is presented. The optimum age for operation, the causes of late deaths, and the incidence of bacterial endocarditis are discussed. FIVE hundred patients were operated on for relief of pulmonary stenosis or atre-sial, 2 by Dr. Alfred Blalock and his associates between November 29, 1944, and September 25, 1947. Eight-one of these patients died at or within the first 6 months of operation, and 30 patients had exploratory thoracotomies only. Thus there 389 patients among the first 500 who survived 6 months or longer after surgery. Sixty-seven of the 389 patients have been lost from follow-up. Eleven patients who survived surgery were unimproved by their first operation. In addition, there were 67 on whom a 5-year checkup was not completed at the time this study was closed. None of these patients are included. Therefore this study is concerned primarily with the 244 patients originally improved by surgery and whose present status is known. On all those living, a teleroentgenogram, at least 2 of the 3 standard measurements of the red blood cell count, and, in many instances, determination of the arterial oxygen saturation before operation and 5 to 8 years after surgery have been obtained. Most of these patients were examined by the physicians in the Cardiac Clinic of the Harriet Lane Home. For the remainder we are indebted to their personal physicians for sending us their reports. As in a previous report,3' 4the results are classified as good or fair. A good result means that after operation the exercise tolerance is virtually normal, and the red blood cell count, hemoglobin, and hematocrit have returned to nearly normal levels. A fair result means that although the patient showed some improvement after operation, he still suffered from limitation of …