Glossary for Adult Congenital Heart Disease, B—B

Baffes operation

Anastomosis of the right pulmonary veins to the RA and the IVC to the LA by using an allograft aortic tube to connect the IVC and the LA. (Baffes TG. A new method for surgical correction of transposition of the aorta and pulmonary artery. Surg Gynecol Obstet 1956; 102:227-233.) This operation provided partial physiologic correction in patients with complete TGA. Lillehei and Varco originally described such a procedure in 1953. (Lillehei CW, Varco RL. Certain physiologic, pathologic, and surgical features of complete transposition of great vessels. Surgery 1953; 34:376-400.)

baffle

A structure surgically created to divert blood flow. For instance, in atrial switch operations for complete transposition of the great vessels, an intra-atrial baffle is constructed to divert systemic venous return across the mitral valve thence to LV and pulmonary artery, and pulmonary venous return across the tricuspid valve thence to RV and aorta. See also Mustard procedure(operation) and Senning procedure.

balanced

As in "balanced circulation, " e.g. in the setting of VSD and PS. The pulmonary stenosis is such that there is neither excessive pulmonary blood flow (which might lead to pulmonary hypertension) nor inadequate pulmonary blood flow (which might lead to marked cyanosis). See also ventricular imbalance.

Bentall procedure

Replacement of the ascending aorta and the aortic valve with a composite graft-valve device and reimplantation of the coronary ostia into the sides of the conduit. (Bentall H, DeBono A. A technique for complete replacement of the ascending aorta. Thorax 1968; 23:338-339.)

• Exclusion technique: the native aorta is resected and replaced by the prosthetic graft.
• Inclusion technique: the walls of the native aorta are wrapped around the graft so that the prosthetic material is "included."

bicuspid aortic valve

An anomaly wherein the aortic valve is comprised of only two cusps instead of the usual three. There is often a raphe or aborted commissure dividing the larger cusp anatomically but not functionally. This anomaly is seen in 2% of the general population and in 75% of patents with aortic coarctation.

bi-directional cavo-pulmonary anastomosis

See Glenn shunt/bi-directional Glenn.

Björk modification

See Fontan procedure/RA-RV Fontan.

Blalock-Hanlon atrial septectomy

A palliative procedure to improve arterial oxygen saturation in patients with complete transposition of the great arteries, first described in 1950. A surgical atrial septectomy is accomplished through a right lateral thoracotomy, excising the posterior aspect of the interatrial septum to provide mixing of systemic and pulmonary venous return at the atrial level. (Blalock A, Hanlon CR. Surgical treatment of complete transposition of aorta and pulmonary artery. Surg Gynecol Obstet 1950;90:1-15.)

Blalock-Taussig shunt

A palliative operation for the purpose of increasing pulmonary blood flow, hence systemic oxygen saturation. It involves creating an anastomosis between a subclavian artery and the ipsilateral pulmonary artery either directly with an end-to-side anastomosis (classical) or using an interposition tube graft (modified). (Blalock A, Taussig HB. The surgical treatment of malformations of the heart in which there is pulmonary stenosis or pulmonary atresia. JAMA 1945;128:189-202.)

Bland-White-Garland Syndrome

The left main coronary artery arises from the main pulmonary artery. The first report describing clinical and pathologic features was published in 1933. (Bland EF, White PD, Garland J. Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am Heart J 1933;8:787:801.) syn. ALCAPA.

bridging leaflets

The superior and the inferior bridging leaflets of the A-V valve are two leaflets uniquely found in association with AVSD. They  "bridge," or pass across, the interventricular septum. When the central part of the bridging leaflet tissue runs within the interventricular septum, the A-V valve is functionally separated into left and right components; when the bridging leaflets do not run within the interventricular septum, but pass over its crest, a common A-V valve guarding a common A-V orifice (with an obligatory VSD) is the result.

Brock procedure

A palliative operation to increase pulmonary blood flow and reduce right to left shunting in tetralogy of Fallot. It involved resection of part of the RV infundibulum using a punch or biopsy-like instrument introduced through the right ventricle so as to reduce RV outflow tract obstruction, without VSD closure. The operation was performed without cardiopulmonary bypass. (Brock RC. Pulmonary valvotomy for the relief of congenital pulmonary stenosis: report of three cases. Br Med J 1948;1:1121-1126.)

bulbo-ventricular foramen

syn. primary foramen, primary ventricular foramen, primary interventricular foramen. An embryological term describing the connection between the left-sided inflow segments (primitive atrium and presumptive left ventricle) and the right-sided outflow segments (presumptive right ventricle and cono-truncus) in the primitive heart tube.