title: Impaired arm development after Blalock-Taussig shunts in adults with repaired tetralogy of Fallot.
abstract: BACKGROUND
  Many adults with repaired tetralogy of Fallot have had prior Blalock-Taussig shunts. These shunts may theoretically hinder growth and development of the ipsilateral arm.
  
  
  METHODS
  We prospectively enrolled consecutive patients with tetralogy of Fallot in a cross-sectional study to measure arm length and assess handgrip strength. Bilateral handgrip strength was quantified by a dynamometer in a standing position after instructing patients to clench each hand tightly in succession. The maximum force achieved, in kilograms, was measured.
  
  
  RESULTS
  A total of 80 consecutive adults with tetralogy of Fallot, aged 36.0 ± 12.5 years, 49% female, were prospectively enrolled. Thirty-eight (47.5%) patients had prior Blalock-Taussig shunts at a median age of 1.0 year. Twenty-one (55.3%) were left-sided and 23 (60.5%) were classic shunts. All but six patients with right-sided shunts and one without a prior shunt were right-handed. The shunts were present for a median of 4.0 years prior to takedown during corrective surgery. The arm ipsilateral to the shunt was significantly shorter than the contralateral arm (71.5 ± 6.1 versus 73.6 ± 5.6 cm, P<0.0001). Handgrip strength was significantly weaker on the ipsilateral versus contralateral side (median [IQR], 26.5 [14.0-41.5] versus 31.0 [18.0-46.0] kg, P<0.0001) and the ipsilateral-to-contralateral handgrip ratio was lower with classic versus modified shunts (median [IQR], 1.05 [1.02-1.14] versus 1.19 [1.07-1.33] kg, P=0.0541).
  
  
  CONCLUSIONS
  In patients with tetralogy of Fallot, Blalock-Taussig shunts may impair normal development of the ipsilateral arm with repercussions in adulthood that include shorter limb length and reduced handgrip strength. These changes are most pronounced in patients with classic end-to-side anastomoses.
authors.affiliation: Montreal Heart Institute Adult Congenital Center, Université de Montréal, Montreal, Canada.
authors.forename: Laurianne
authors.initials: L
authors.lastname: Le Gloan
authors.forename: François
authors.initials: F
authors.lastname: Marcotte
authors.forename: Hugues
authors.initials: H
authors.lastname: Leduc
authors.forename: Lise-Andrée
authors.initials: LA
authors.lastname: Mercier
authors.forename: Annie
authors.initials: A
authors.lastname: Dore
authors.forename: François-Pierre
authors.initials: FP
authors.lastname: Mongeon
authors.forename: Reda
authors.initials: R
authors.lastname: Ibrahim
authors.forename: Joaquim
authors.initials: J
authors.lastname: Miro
authors.forename: Anita
authors.initials: A
authors.lastname: Asgar
authors.forename: Nancy
authors.initials: N
authors.lastname: Poirier
authors.forename: Paul
authors.initials: P
authors.lastname: Khairy
mesh_terms: D000328:Adult; D001132:Arm / Q000254:growth & development*; D058366:Blalock-Taussig Procedure / Q000009:adverse effects* / Q000639:trends; D003430:Cross-Sectional Studies; D005260:Female; D018737:Hand Strength / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D055815:Young Adult