The Blalock-Taussig Shunt

            The Blalock-Taussig shunt or BT Shunt was first performed by renowned heart surgeon Dr. Alfred Blalock on November 29th, 1944.  The procedure is named for him and Dr. Helen Taussig a pediatric cardiologist.  Taussig approached Blalock after being frustrated and powerless to help children with the Blue Baby Syndrome.  The Blue Baby Syndrome gets its name from the blue pallor to the skin of infants and young children who have severe congenital heart defects.  Of the heart defects that cause the blueness, or cyanosis, tetralogy of Fallot is one of the most common.  The blueness comes from the fact that the blood is not as oxygenated as a normal person's blood.  This comes from either complete or partial blockage of blood to the lungs and a mixing of the blood between the two sides of the heart.  The left side of the heart pumps oxygenated blood to the body and the right side pumps blood to the lungs.  The blockage is usually associated with the pulmonary artery, which takes blood from the right side to the lungs, or the pulmonary valve.  The mixing is usually caused by a hole between the ventricles, main pumping chambers.  In cases like tetralogy, the defect causes more blood to pass from the right side of the heart to the left bypassing the lungs, the causes a much lower oxygen presence in the blood than is needed by the body. 

            Taussig noticed that those patients with the Blue Baby Syndrome seemed to survive longer if there was another defect present.  The associated defect is called a patent ductus arteriosis.  Everyone is born with a connection, called the ductus arteriosis, between the aorta, which takes blood to the body, and the pulmonary artery so that the lungs are bypassed when they are not working before birth.  The connected closes usually within a few hours or few days of birth.  Sometimes this connection stays open and causes a mixing of the blood.  In the case of tetralogy of Fallot due to the blockage in the pulmonary artery the blood flow in the ductus to be in the other direction thus sending blood to the lungs.  Taussig believed that there should be a way of reconnection the major arteries to get more blood to the lungs.  At the time Blalock had been working with his lab technician, Vivian Thomas, in procedures associated with shock and the side effect was more blood sent to the lungs.  He believed he could modify that procedure for blue babies.  He brought the problem up with Thomas who began to work on it.

            Thomas had planned to go to medical school when the depression hit and left him penniless.  He sought work and got a job as Blalock's lab assistant.  Blalock noticed the skill Thomas had and Thomas' interest in his surgical notes and books.  Blalock taught Thomas in surgical techniques and Thomas became his lab technician.  In order to test his how a modification of his procedure would work they needed to recreate the condition in lab dogs.  This was Thomas' job.  After some experimentation, Thomas was able to replicate the condition in a lab dog.  He then went on the modify Blalock's shock procedure and was successful.  He had to modify some of the instruments he used so they would work properly for a human patient.  Many of today’s surgical instruments come from what Thomas had originally done.  He then taught the modified procedure to Blalock.  The basic procedure is connecting the left sub-clavien artery, which is an artery that carries blood to the arm, to the left pulmonary artery.  This created an artificial ductus arteriosis.

            When the time Blalock felt confident enough to perform the procedure on a human, the surgery was scheduled.  The first patient was 9 pound baby girl named Eileen with tetralogy of Fallot.  Blalock, a little uncertain, had Thomas brought into the operating theater to observe and guide him during the surgery.  Thomas did direct and observe the surgery from behind Blalock's right shoulder standing on a step stool.  Besides widely opening up the field of cardiac surgery is the fact that the major work on this procedure was done by Thomas, a young black man living during the era of the Jim Crow laws.  If it were not for him I probably would not be here today.  The BT shunt was my second surgery on my heart and allowed me to grow so that the total correction could be done on me.  I was born with tetralogy of Fallot with pulmonary atresia.  My defect caused a total blockage of blood to the lungs but this surgery was one of two that helped keep me alive until the total correction surgery was done.  All of this is possible because of Taussig, Blalock, and especially Thomas.

Here is a scene from Something the Lord Had Made, dramatizing the first attempt of the surgery: