LAUSR

Tetralogy of Fallot (ToF) was first described by the Danish Nicolas Steno in 1671, but the defect bears an eponymous name after the French doctor Etienne Louis Arthur Fallot, who associated the clinical symptoms with the autopsy image of a malformed heart (1888).1 For decades, the condition was considered untreatable. Infants with cyanosis were called ‘blue babies’. One of the most famous patients was Dick Ket, a Dutch painter known for his self-portraits. He was born in 1902 with ToF and dextrocardia, and, in his paintings, he documented the symptoms of disease progression, such as severe cyanosis and finger clubbing. He died at the age of 38 years. Four years later, the first palliative procedure for ToF was performed. The history of surgical approach to repair some cardiac defects without a cardiopulmonary bypass is a fascinating journey into the field of cardiovascular surgery. In 1938, Robert Gross from Boston Children’s Hospital ligated the patent ductus arteriosus (PDA) in a 7-year-old girl, and this date is considered as the beginning of congenital heart surgery. Dr Helen Taussig (figure 1) recognised that her patients with right ventricular outflow tract obstruction died of anoxemia when the ductus arteriosus underwent physiological obliteration. She deduced that if PDA ligation, as exemplified by Gross, was both feasible and successful for pulmonary plethora, then the creation of a conduit or duct to increase pulmonary blood flow would also be surgically possible for her patients. In 1939, she met Dr Gross and presented him with her idea of an artificial duct. However, Robert Gross was not interested in it, observing that he had enough problems trying to close the duct without creating one. A few years later, he admitted that what he had said was the most stupid statement he made in his entire life.2 It was …