The Waterston Shunt: A Commentary

Abstract

The Waterston shunt was first discussed in the medical literature in 1962 in an article published in a Czechoslovakian journal as a dedication to the 60th birthday of Professor V. Kalek [I]. The Waterston operation is a side-to-side anastomosis between the ascending aorta and the right pulmonary artery, and Waterston [l] probably was the first to mention the use of the subclavian artery as a free graft between the descending aorta and pulmonary artery. Waterston also recommended the use of this type of systemic-pulmonary shunt in cyanotic patients under 1 year of age, as it afforded relief of the cyanosis and was essential to survival. For several years after its introduction, the Waterston shunt was considered the operation of choice if a palliative procedure were contemplated. Interestingly, Waterston published his technique more than 15 years after the more popular shunt procedure described by Blalock and Taussig [2] in 1945 and Potts and colleagues (31 in 1946. Waterston probably presented his shunt procedure so much later because of the reported failures and disadvantages of the Blalock and Potts shunts. By 1961 it had become evident that the Blalock shunt sometimes failed in infants because of kinking of the subclavian artery or because the artery was too short and that the Potts shunt presented a difficult problem when total repair of the anomaly was attempted. In 1966, Edwards and co-workers [4] published an article describing a side-to-side anastomosis between the ascending aorta and right pulmonary artery. They stated that this procedure had not been reported before. Obviously, the procedure had been published before, but in a journal not commonly read, and thus was unknown to most surgeons, including the authors. The same procedure again was described in 1966 by authors Cooley and Hallman [5]. They apparently were either unaware of Waterston’s earlier publication, or misinterpreted Waterston’s procedure as different from theirs. Probably as a result of this article, the Waterston shunt sometimes has been referred to as the Waterston-Cooley anastomosis. Had the Waterston procedure been reported in a more widely read journal, its popularity more than likely would have been greater and its origin less controversial. From 1965 to well into the early 1980s, several publica-