Clarkson, P. M.

Two cases of severe neurologic symptoms after a Blalock-Taussig anastomosis are presented in detail. The histories of 116 patients with cyanotic congenital heart disease who had such an anastomotic operation at the Mayo Clinic were reviewed. There was a low incidence (less than 1%) of postoperative neurologic complications in patients without evidence of focal dysfunction of the central nervous system prior to operation. The review suggested an increased incidence of complications in those patients with a cerebrovascular abnormality before surgery. It is likely that these complications are related to alterations in the vertebrobasilar arterial system associated with this procedure.

The status of 58 patients, 3 to 57 years of age, with ventricular septal defect and a marked increase in pulmonary vascular resistance (pulmonary obstructive disease) was determined 5 years or longer after diagnostic catheterization. Forty-six (80%) were alive 5 years after that study. The probability of living 5 years was 95% for patients aged 10 through 19 years and 56% for those 20 years of age or older. The dissimilarity of actuarial curves between these two groups is consistent with the hypothesis that pulmonary vascular obstructive disease develops under age 20. Calculated pulmonary resistance increased with age of patient on admission to the study, suggesting its progressive nature. Hemoptysis was rare under age 20, and its presence over this age indicated a poor prognosis. The most common causes of death were "sudden" or "unknown." Most surviving patients were gainfully employed or attending school without severe symptoms.