Surgery & Anesthesia · 1944
The Blalock-Taussig Shunt (first "blue baby" operation)
Before November 1944, a diagnosis of tetralogy of Fallot in an infant was a sentence with no surgical appeal. The infants were cyanotic, growth-restricted, and frequently died before school age; the heart was considered untouchable by most surgeons of the era. Helen Taussig, who ran the pediatric cardiac clinic at Johns Hopkins and had become expert at auscultation and cardiac fluoroscopy despite progressive hearing loss, noticed something the textbooks had not emphasized: infants with Fallot's tetralogy who also had a patent ductus arteriosus survived longer and appeared less blue. The ductus was funneling extra blood toward the lungs.
Taussig brought this observation to Alfred Blalock, the chief of surgery at Hopkins, and proposed creating a surgical shunt that would mimic what the ductus provided naturally. Blalock had extensive experience with vascular anastomoses from his experimental work on shock and hypertension. The technical preparation for the operation was carried out largely by Vivien Thomas, a Black surgical technician who had worked with Blalock since his Vanderbilt years. Thomas performed hundreds of animal experiments, refining the anastomotic technique on small pulmonary vessels before any surgeon attempted it on a patient.
On November 29, 1944, Blalock anastomosed the subclavian artery to the pulmonary artery in a 15-month-old girl who weighed less than 4.5 kg. She survived the operation, and the cyanosis that had marked her face and fingertips receded visibly in the operating room. Two more operations in the first series also succeeded. The case series was published in JAMA in 1945, generating immediate and widespread attention in the surgical community.
The shunt did not correct the underlying anatomy; it was palliation, not cure. But it demonstrated that the great vessels adjacent to the heart could be dissected, clamped, and sewn without killing the patient, an assumption no surgeon had tested before. That demonstration opened the field. Within a decade, surgeons were attempting increasingly complex intracardiac repairs, culminating in the era of open-heart surgery with cardiopulmonary bypass.
Vivien Thomas received no credit in the original publication. His contribution was widely known within Hopkins but not publicly acknowledged for decades. In 1976, Johns Hopkins awarded him an honorary doctorate, and in 1979 his portrait was hung in the hospital alongside those of Blalock and Taussig. The modified Blalock-Taussig shunt, using a synthetic interposition graft, remains in current use as a staged palliation for several forms of cyanotic congenital heart disease.
Key People
- Alfred Blalock — Chief of surgery at Johns Hopkins; performed the first shunt operations
- Helen Taussig — Cardiologist who conceived the surgical strategy based on her clinical observations
- Vivien Thomas — Surgical technician who developed and refined the operative technique in animal models
JAMA. 1945;128:189-202.
Related landmarks
- 1954 · First Successful Kidney Transplant (Surgery & Anesthesia)
- 1966 · National Halothane Study (Surgery & Anesthesia)
- 1967 · First Human Heart Transplant (Surgery & Anesthesia)
- 1968 · Coronary Artery Bypass Grafting (CABG) (Surgery & Anesthesia)