INTRODUCTION

Ever since GROSS performed the first successful operation on the heart (August 26, 1938) by ligating a patent ductus arteriosus, interest in surgical treatment of congenital cardiac disease has steadily increased. For persons severely disabled by morbus caeruleus-“blue babies”-with stenosis or atresia of the pulmonary artery, the BLALOCK-TAUSSIG anastomosis (first performed on November 29, 1944) brought hope of considerable alleviation by diversion of incompletely oxygenated blood from the systemic to the pulmonary circulation. The first operations of this type in Sweden were performed in 1947 by P. Sandblom at Kronprinsessan Lovisa’s Children’s Hospital and C. Crafoord at Sabbatsberg Hospital. POTTS’ (19-16) modification of the shunt operation, with direct aorticopulmonary anastomosis, has also been used in later years. In many “blue babies” these shunt procedures have led to improvement. Their true purpose, however, is to be regarded as palliation by increasing the flow of blood through the lungs. The anatomic defects remain even when the results otherwise are good. More recently, shunting operations have largely been superseded by open-heart surgery in which septa1 defects are closed and pulmonary stenosis is corrected. This development has been made possible mainly by the evolution of cross circulation or continuous arterial reservoir perfusion (LILLEHEI ET AL. 1955), the development of safe extracorporeal techniques, the advances in intracardiac corrective surgery and the use of cardioplegia (KIRKLIN ET AL. 1959). Among the group of defects known as morbus caeruleus, the tetralogy of Fallot is widely considered to be specially suitable for intracardiac repair. Despite selection of cases the surgical mortality was high to begin with-substantially higher than in shunting procedures. In the past two years, however, the mortality from open-heart surgery has greatly declined, indicating that many problems associated with the technique have now largely been solved. Since the tendency from all appearances is towards radical correction of the intracardiac defects, there would seem to be a need for long-term evaluation of extracardiac anastomosis in the treatment of morbus caeruleus. As well as the merits of the method, its future usefulness as compared