Vertebrobasilar ischemia after total repair of tetralogy of Fallot: significance of subclavian steal created by Blalock-Taussig anastomosis. Vertebrobasilar ischemia after correction of tetralogy of Fallot.

Patients who have undergone a Blalock-Taussig anastomosis for treatment of congenital heart disease may have the vascular anatomy of the subclavian steal syndrome. Cerebral ischemia has been reported in such patients, but not when total surgical correction has eliminated other predisposing factors. We report a patient who developed vertebrobasilar insufficiency 31 years after Blalock-Taussig anastomosis and 4 years after total intracardiac repair of tetralogy of Fallot. He had angiographically proven subclavian steal and no other known predisposing factor for cerebral ischemia. This case suggests that symptomatic subclavian steal may be a late risk of surgical treatment of congenital heart disease that leaves the vascular anatomy of subclavian steal intact. Vascular reconstructive surgery can be effective treatment for these patients and may be indicated prophylactically at the time of intracardiac repair if subclavian steal syndrome becomes a more frequently recognized sequela of prior Blalock-Taussig anastomosis.