Fallot: Palliation with BT shunt

Tetralogy of Fallot (TOF) is a constellation of conotruncal anomalies involving anterior malalignment of the conal septum and right ventricular outflow tract obstruction. When symptomatic in the neonatal period or early infancy, it can be treated either by complete surgical repair or by initial palliation with a systemic to pulmonary shunt, most commonly in the form of a modified Blalock-Taussig shunt. This chapter describes the details of the surgical technique used to perform a BT shunt. The procedure continues to carry a relatively high mortality rate close to 4 %. The chapter also discusses perioperative management including preoperative evaluation, decision making and important aspects of postoperative anticoagulation.