The history of cardiovascular medicine has progressed in a finite number of decades. This is only due to the valiant stories of pioneers in the field of medicine. The Blalock-Taussig-Thomas shunt or BT shunt is also the tale of sensational discovery by fine individuals. The development of the shunt was first initiated by Dr. Helen Taussig, she was a prominent pediatric cardiologist at John Hopkins.
Dr. Helen worked on congenital heart disease and rheumatic fever. While working on patients she developed a particular interest in infants with cyanosis which was often caused by Tetralogy of Fallot (TOF) (1). This caused the 'blue baby syndrome'. The first new surgery was performed in the year 1939 by Dr. Robert Gross which was corrective surgery for patent ductus arteriosus. She observed that when the TOF patients who have a patent ductus arteriosus thrived better and showed longer survival (2). She fairly conducted that when the patent ductus closes naturally, the patients tend to often begin or worsen with cyanotic episodes. She found herself helpless due to the exponential increase in these cases. At that time, Dr. Alfred Blalock was appointed as the surgeon-in-chief at John Hopkins. In 1941, Dr. Taussig suggested the idea of creating a ductus to the pulmonary artery which might increase the pulmonary blood flow.
Dr. Blalock hired Vivien Thomas as his lab assistant to carry out his experiments. Along with managing lab work, Thomas quickly got preceptive on surgical procedures and learned to perform them. He became an essential part of Blalock's research in developing a treatment for hemorrhagic and shock treatment, which developed in the study of crush syndrome (3). When Dr. Taussig asked Dr. Blalock to perform a palliative surgery, he immediately asked Thomas to team up. The starting point of the treatment became collectively revisiting vascular surgical techniques which they had used in hypertension experiments. During their trial, they shunted the subclavian artery to the pulmonary artery which increased the blood flow to the lungs. Later, Thomas studied the specimens at John Hopkin University for a year and only then he reproduced it on the four-part anomaly of Tetralogy of Fallot in a dog's heart (3). Furthermore, for almost two years they collectively did this procedure on over 200 canines to demonstrate that it is non-fatal.
On the morning of November 29th in the year 1944, Dr. Blalock and Dr. Taussig decided to proceed with the crucial anastomosis of the subclavian artery to the pulmonary artery. The patient was 2-year-old Eileen Saxon. During this surgery, Vivien stood behind Dr. Blalock and guided him through the procedure. He took an anterolateral incision in the third interspace, and the second and third costal cartilages were divided. The anastomosis was made at the shortened end of the subclavian artery to the side of the pulmonary artery. When he released the bulldog, and the systemic blood was transferred into the pulmonary artery. Finally, they knew history was created (4).
After 2 weeks of post-operative complications and progressive recovery, Eileen left the hospital. Some weeks later, the shunt was occluded, and its attempt to improve the cyanosis with another shunt was attempted. Unfortunately, she did not survive (4). They later repeated it which led to two successful attempts. Though Eileen succumbed, her contribution to this trial went on to save millions of lives.
Surgeon Dr. Blalock and cardiologist Dr. Taussig went on to publish their article, where they were credited with the name Blalock-Taussig shunt. Vivien Thomas was not recognized immediately due to a lack of academic background but was awarded a doctorate by John Hopkins Institute for his outstanding contribution (5).
Since then, many modifications were made by different surgeons for correcting congenital defects of the heart by using different types of synthetic grafts. The journey of the BT shunt was so miraculous that even today it is used as a palliative surgery. Dr. Helen Taussig, Dr. Alfred Blalock, and Vivien Thomas all collectively changed the fate of TOF patients with their persistent efforts, knowledge, and courage. In 2004, a movie named 'Something the Lord Made' beautifully portrayed this surgical expedition in a cinematic form on a large scale.
References:
1.Neill, C A; Clark, E B (1994). "Tetralogy of Fallot. The first 300 years". Texas Heart Institute Journal. 21 (4): 272–279.
2. Van Robays, J (2016). "Helen B. Taussig (1898-1986)". Facts, Views & Vision in ObGyn. 8 (3): 183–187. ISSN 2032-0418.
3.Just One More | Vivien Thomas: Remembering a Pioneering Legend. Feb 04, 2021Cardiology Magazine
4. Denton A. Cooley, MD. The first Blalock–Taussig shunt. The Journal of Thoracic and Cardiovascular Surgery c October 2010. ;140:750-1 0022-522
5. Dr. Zbigniew Religa. The Blalock-Taussig-(Thomas) Shunt. October 27, 2013. A Medical Anthology.
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