Giant Aneurysm of a Classic Blalock-Taussig Shunt in Adult Tetralogy of Fallot Publisher

Summary: Can childhood heart surgery pose risks decades later? A case reports a late aneurysm after a classic BT shunt, supporting lifelong imaging follow-up. #CardiacSurgery #Surveillance

Borjian S ; Hosseinsabet A ; Aslfallah S ; Ghaderian H ; Torabi N ; Maleki F ; Hajiali A
Source: JACC: Case Reports Published:2026

Abstract

Background: Giant aneurysmal degeneration of a classic Blalock–Taussig (BT) shunt is a rare, life-threatening late complication of tetralogy of Fallot (TOF) palliation. Case: A 47-year-old woman with unrepaired TOF palliated in childhood presented with exertional dyspnea and a right thoracic mass. Echocardiography revealed severe right ventricular outflow tract obstruction, a large ventricular septal defect, and a pulsatile extracardiac structure. Computed tomography and cardiac magnetic resonance imaging confirmed a giant (72 × 66 mm) true aneurysm of a right BT shunt. She underwent successful aneurysm excision, ventricular septal defect closure, right ventricular outflow tract reconstruction, and pulmonary valve replacement. Discussion: This case demonstrates a rare late complication of a classic BT shunt decades after TOF palliation. Conclusion: Classic BT shunts may develop life-threatening aneurysmal degeneration decades after palliation, emphasizing lifelong surveillance and timely definitive management. Take-Home Message: Lifelong imaging surveillance and multimodality imaging are essential for detecting late vascular complications. © 2026 The Authors