Symptomatic aortic regurgitation after Blalock-Taussig shunt in tetralogy of Fallot with bicuspid aortic valve.

We report here a case of a premature baby with tetralogy of Fallot and bicuspid aortic valve. After the successful completion of the Blalock-Taussig (BT) shunt, severe aortic valve regurgitation (AR) appeared, although it was trivial preoperatively. Severe postoperative heart failure was induced by progression of the AR. Postoperative echocardiography revealed that the progression of the AR was provoked by appearance of prolapse of the cusp as the result of rapid increase of blood flow through the aortic valve after the BT shunt. We propose that, in planning the BT shunt for patients with tetralogy of Fallot, preoperative examinations for a possible bicuspid aortic valve should be done and postoperative precaution considering possible appearances of severe AR and congestive heart failure will be necessary.