The brock operation for pulmonary stenosis: Review of thirty-nine cases

Abstract

O NE of the greatest accomplishments of modern cardiac surgery has been the development of operative procedures for the relief of pulmonary stenosis. Two main groups of procedures have been devised. These are the establishment of extracardiac shunts, as in the Blalock I and Potts 2 operations, and a direct attack upon the stenotic pulmonary valve or infundibulum according to the method of B r o c k 2 It is generally accepted that in the case of pulmonary stenosis with intact ventricular septum the Blalock procedure is contraindicated ~ and the valve must be dealt with directly by Brock's method. Brock ~ was the first to advocate that the pulmonary stenosis associated with the tetralogy of Fallot also could be relieved by his procedure. Experience has shown, however, that the type of operation indicated in the tetralogy of Fallot varies with the anatomic peculiarities of a given case. Precise preoperative anatomic diagnosis has, therefore, become of great practical importance rather than of merely academic interest. T h e surgeon would like to know preoperatively what type of stenosis is present: valvular, postvalvular, infundibular, or combined valvular and infundibular. If an infundibular stenosis is present, is the