Cerebral ventriculomegaly after the bidirectional Glenn (BDG) shunt: a single-institution retrospective analysis

Morgan, Clinton D.; Wolf, Michael S.; Le, Truc M.; Shannon, Chevis N.; Mettler, Bret A.

doi:10.1007/s00381-015-2881-5

Cited by 10 publications

(4 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These infants were noted to have increasing ventricular size with concomitant increases in central venous pressure after cardiac intervention, which suggests the importance of the CSF absorption gradient and CSF pulsatility in infants. 11 As a result, we hypothesized that hydrocephalic infants with cardiac disease (a proxy for increased central venous pressure) were more prone to ETV/CPC failure.…”

Section: Infantile Csf Absorptionmentioning

confidence: 99%

“…6 In addition, infants with a single ventricle syndrome and higher documented central venous pressure have been noted to experience worsening intracranial pressure with increasing ventricular size. 11 With these results in mind, the theory that congenital cardiac defects produce higher central venous pressure (and therefore worsen ventriculomegaly/hydrocephalus) should be investigated.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure

Shah

Ibrahim

Sasaki

et al. 2018

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

OBJECTIVEAlthough endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) has gained increasing prominence in the management of hydrocephalus caused by intraventricular hemorrhage of prematurity, the rates of long-term shunt independence remain low. Furthermore, limited evidence is available to identify infants who might benefit from the procedure. The authors tested the hypothesis that elevated venous pressure that results from comorbid cardiac disease might predispose patients to ETV/CPC failure and shunt dependence.METHODSA retrospective analysis was performed on a consecutive series of 48 infants with hydrocephalus who underwent ETV/CPC and also underwent preoperative echocardiography between 2007 and 2014. Comorbid cardiac abnormalities that are known to result in elevated right heart pressure were reviewed. Associations between ETV/CPC success and the presence of pulmonary hypertension, right ventricular hypertrophy, left-to-right shunting, ventricular septal defect, or patent ductus arteriosus were determined using multivariate logistic regression analysis.RESULTSOf the 48 children who met the inclusion criteria, ETV/CPC failed in 31 (65%). In univariate analysis, no single echocardiogram abnormality was associated with shunt failure, but the presence of 2 or more concurrent echocardiogram abnormalities was associated with ETV/CPC failure (17 [85%] of 20 vs 14 [50%] of 28, respectively; p = 0.018). In multivariate logistic regression analysis, when the authors adjusted for the child’s ETV success score, the presence of 2 abnormalities remained independently associated with poor outcome (2 or more echocardiogram abnormalities, OR 0.13, 95% CI 0.01–0.7, p = 0.032; ETV success score, OR 1.1, 95% CI 1–1.2, p = 0.05).CONCLUSIONSIn this study, cardiac abnormalities were inversely associated with the success of ETV/CPC in infants with hydrocephalus of prematurity. ETV/CPC might not be as efficacious in patients with significant cardiac anomalies. These results provide a basis for future efforts to stratify surgical candidacy for ETV/CPC on the basis of comorbid abnormalities. Proper cardiac physiological pressure monitoring might help elucidate the relationship between cardiac abnormalities and hydrocephalus.

show abstract

Section: Infantile Csf Absorptionmentioning

confidence: 99%

mentioning

confidence: 99%

Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure

Shah

Ibrahim

Sasaki

et al. 2018

Journal of Neurosurgery: Pediatrics

View full text Add to dashboard Cite

show abstract

“…A case report highlighted the rise of ICP in the context of irritability after the Glenn procedure, confirmed by brain MRI, fundal examination, and elevated opening pressure in lumbar puncture ( 34 ). Furthermore, brain imaging in 24 patients before and after the Glenn procedure revealed ventriculomegaly linked to higher CVP ( 35 ). These cases align with our findings regarding the elevation of ICP following Glenn procedure.…”

Section: Discussionmentioning

confidence: 99%

Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure

Jijeh,

Fatima,

Faraji

et al. 2024

Critical Care Explorations

View full text Add to dashboard Cite

OBJECTIVES: This prospective cohort study aimed to investigate changes in intracranial pressure (ICP) and cerebral hemodynamics in infants with congenital heart disease undergoing the Glenn procedure, focusing on the relationship between superior vena cava pressure and estimated ICP. DESIGN: A single-center prospective cohort study. SETTING: The study was conducted in a cardiac center over 4 years (2019–2022). PATIENTS: Twenty-seven infants with congenital heart disease scheduled for the Glenn procedure were included in the study, and detailed patient demographics and primary diagnoses were recorded. INTERVENTIONS: Transcranial Doppler (TCD) ultrasound examinations were performed at three time points: baseline (preoperatively), postoperative while ventilated (within 24–48 hr), and at discharge. TCD parameters, blood pressure, and pulmonary artery pressure were measured. MEASUREMENTS AND MAIN RESULTS: TCD parameters included systolic flow velocity, diastolic flow velocity (dFV), mean flow velocity (mFV), pulsatility index (PI), and resistance index. Estimated ICP and cerebral perfusion pressure (CPP) were calculated using established formulas. There was a significant postoperative increase in estimated ICP from 11 mm Hg (interquartile range [IQR], 10–16 mm Hg) to 15 mm Hg (IQR, 12–21 mm Hg) postoperatively (p = 0.002) with a trend toward higher CPP from 22 mm Hg (IQR, 14–30 mm Hg) to 28 mm Hg (IQR, 22–38 mm Hg) postoperatively (p = 0.1). TCD indices reflected alterations in cerebral hemodynamics, including decreased dFV and mFV and increased PI. Intracranial hemodynamics while on positive airway pressure and after extubation were similar. CONCLUSIONS: Glenn procedure substantially increases estimated ICP while showing a trend toward higher CPP. These findings underscore the intricate interaction between venous pressure and cerebral hemodynamics in infants undergoing the Glenn procedure. They also highlight the remarkable complexity of cerebrovascular autoregulation in maintaining stable brain perfusion under these circumstances.

show abstract

“…In fact, at a PVR of 7 Wood units-m 2 , the SVC pressure was around 15 mmHg, which is 28% higher than that of the BDG. Since newborns experience episodes of high PVR, such high SVC pressure could potentially cause other complications, including cerebral ventriculomegaly, recanalization, and obliterated vessels [30][31][32]. The elevated SVC pressure at high PVR can be understood by two competing effects: the first is the ejector pump effect that reduces the upstream (SVC) pressure relative to the downstream (PA) pressure.…”

Section: Introductionmentioning

confidence: 99%

Characterization of the Ejector Pump Performance for the Assisted Bidirectional Glenn Procedure

Jia

Esmaily

2022

Fluids

View full text Add to dashboard Cite

This study introduces an algebraic model informed by computational fluid dynamics (CFD) simulations to investigate the performance of the assisted bidirectional Glenn (ABG) operation on a broad range of conditions. The performance of this operation, as measured by the superior vena cava (SVC) pressure, depends on the nozzle area in its ejector pump and the patient’s pulmonary vascular resistance (PVR). Using the developed algebraic model to explore this two-dimensional parameter space shows that the ejector pump can create a pressure difference between the pulmonary artery and the SVC as high as 5 mmHg. The lowest SVC pressure is produced at a nozzle area that decreases linearly with the PVR such that, at PVR =4.2 (Wood units-m2), there is no added benefit in utilizing the ejector pump effect (optimal nozzle area is zero, corresponding to the bidirectional Glenn circulation). At PVR =2 (Wood units-m2), the SVC pressure can be lowered to less than 4 mmHg by using an optimal nozzle area of ≈2.5 mm2. Regardless of the PVR, adding a 2 mm2 nozzle to the baseline bidirectional Glenn boosts the oxygen saturation and delivery by at least 15%. The SVC pressure for that 2 mm2 nozzle remains below 14 mmHg for all PVRs less than 7 Wood units-m2. The mechanical efficiency of the optimal designs consistently remains below 30%, indicating the potential for improvement in the future. A good agreement is observed between the algebraic model and high-fidelity CFD simulations.

show abstract

Cerebral ventriculomegaly after the bidirectional Glenn (BDG) shunt: a single-institution retrospective analysis

Cited by 10 publications

References 21 publications

Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure

Multiple echocardiography abnormalities associated with endoscopic third ventriculostomy failure

Intracranial Pressure and Cerebral Hemodynamics in Infants Before and After Glenn Procedure

Characterization of the Ejector Pump Performance for the Assisted Bidirectional Glenn Procedure

Contact Info

Product

Resources

About