Blalock-Taussig Operation

 Definition

Blalock-Taussig operation (also called Blalock-Thomas-Taussig shunt) is a palliative surgical procedure used in cyanotic heart defects. More specifically it is used for the palliative repair of blue babies or those infants diagnosed with Tetralogy of Fallot (TOF). In this procedure the blood flow is directed to the lungs to relive cyanosis while the infant is waiting for the corrective surgery.

Children with TOF and other cyanotic defects have problems with oxygenation. Cyanosis develops as a result of low oxygen levels in the blood. Placement of a blalock-taussig shunt alleviate symptoms of poor oxygenation (e.g. cyanosis) which is done by anastomosing the subclavian artery to the pulmonary artery (bypassing the stenosed pulmonary artery) so that part of hypoxemic blood in the aorta will be oxygenated in the lungs.

History

The procedure was named after Alfred Blalock, a surgeon and Helen B. Taussig, a cardiologist. The procedure was developed by the two physicians together with Blalock’s laboratory technician Vivien Thomas. Taussig (cardiologist) observed that children with cyanotic heart defect and patent ductus arteriosus (PDA) live longer than those without PDA. The cardiologist then formulated a theory that placement of a shunt mimicking the function of PDA might provide relief for tetralogy of fallot’s problem on oxygenation. Dr. Taussig approached Dr. Blalock and Thomas in their laboratory. After meeting with Taussig the two men set about perfecting the procedure on animals which later on they performed on infants. This operation was first done on November 29, 1944 at the Johns Hopkins Hospital in Baltimore and is a major landmark in the history of children’s heart surgery.

Indications Blalock-Taussig Operation

• Cyanotic heart defects
• Tetralogy of Fallot – congenital heart disease that is characterized by four anomalies: ventricular septal defect, pulmonary stenosis, dextroposition (overriding) of aorta and hypertrophy of right ventricle.

Nursing Management

Before the procedure

1. Discontinue Aspirin 14 days before the operation to decrease the risk of excessive bleeding. Check the medication regimen with the cardiologist because there may be a medical reason for the continued use of aspirin.
2. Blood typing is done prior to surgery and blood should be ready for transfusion anytime within and after surgery in cases of excessive bleeding.
3. Chest x-ray, electrocardiogram and laboratory work will be performed as a preoperative process
4. Have the parents sign the informed consent.
5. NPO post midnight.
6. IV fluids.
7. Explore feelings of anxiety of the patient (if adult and older children) and/or child’s parents (for infants and children).

After the procedure

1. Monitor patient’s heart rate and rhythm closely.
2. Chest x-ray is performed after the operation.
3. Administer medications that reduce pain.
4. Comfort measures should be done.
5. Once surgical dressing is removed, the incision will remain open to air.
6. Incision should be cleansed twice a day with a Betadine solution.
7. Small gauze is placed over the insertion sites of chest tubes, intracardiac lines and pacing wires.
8. Prophylactic antibiotic.
9. Patients with sternotomy should avoid strenuous activity that causes strain on the chest for at least 6-8 weeks to promote healing of the breastbone.
10. Avoid picking infants by arms rather scoop them to avoid straining the chest area.
11. Older children and adults should avoid contact games or sports and activities involving pushing and pulling with arms.
12. Instruct the family to observe the following after discharge and report immediately to the doctor if noticed:
    • Redness, swelling or oozing of blood from the incision
    • Fever
    • Altered mental status
    • Feeding problems
    • Excessive fatigue
    • Prolonged and worsening pain

Possible Complications of Blalock-Taussig Surgery

• Bleeding
• Infection
• Nerve damage (in the chest area)
• Need for re-operation
• Adverse reaction to anesthesia
• Brain damage
• Death