Physiological rationale for a bidirectional cavopulmonary shunt

Hopkins, Richard A.; Armstrong, Brenda E.; Serwer, Gerald A.; Peterson, Richard J.; Oldham, H. Newland

doi:10.1016/s0022-5223(19)38595-2

Cited by 191 publications

(56 citation statements)

References 43 publications

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“…Since the BUCP anastomosis was shown to be superior [3] when compared to the original procedure proposed by GLENN [4], the operation started to be used generally together with cardiopulmonary bypass (CPB). In 1990, LAMBERTI et al [5] reported the possibility of preparing the anastomosis utilizing a temporary venoatrial shunt without CPB.…”

Section: Introductionmentioning

confidence: 99%

<![CDATA[<b>Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass?</b>]]>

Crotti¹,

Braile²,

Godoy³

et al. 2004

Braz. j. cardiovasc. surg.

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Objective: To compare patients who underwent the Bidirectional Glenn Operation with and without cardiopulmonary bypass (CPB), analyzing the characteristics and confirming if there is superiority of either of the employed techniques. patients with complex heart defects were submitted to this operative technique. The mean age of the patients was 19 months and 14 were female. The patients were divided into two groups: Group A with 7 patients (using CPB) and group B with 9 patients (without the use of CPB). Gender, age, mean pulmonary artery pressure (MPAP), CPB time, aortic clamping time, venoatrial shunt, previous operations, time in intensive care unit (ICU), total hospitalization time and immediate complications were all compared between the two groups.Results: The median MPAP was 13 mmHg. In group A the CPB time was 91 ± 47 minutes (57-195 minutes), myocardial ischemia was 25 ± 33 minutes (0-80 minutes). Of these, four patients required intracardiac procedures or enlargement of the pulmonary branches and in three, CPB assistance as ventilatory support was needed. In group B the venoatrial shunt was 21 ± 10 minutes (0-39 minutes). The time to extubation was 9 ± 13 hours with a median of 3 hours (1-43 hours). The ICU stay was 8 ± 12 days with a median of 5 days (1-50 days). Hospitalization was 12 ± 12 days with a median of 7 days (0-50 days). Five patients had been submitted to surgeries previously. Two, one patient from each group, died (12.5%). No neurological complications, pleural or pericardial effusions were observed. No significant differences were evidenced between the two groups in respect to all the variables studied.Conclusion: In spite of the relatively small cohort, this study suggests that the bidirectional Glenn operation can be performed with or without CPB giving similar results in respect to morbidity and mortality. Thus, the operation without CPB can be safely employed when the anatomic findings are appropriate and there is no severe hypoxia.

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Section: Introductionmentioning

confidence: 99%

<![CDATA[<b>Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass?</b>]]>

Crotti¹,

Braile²,

Godoy³

et al. 2004

Braz. j. cardiovasc. surg.

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“…The main aim is to allow low continuous blood flow to pulmonary arteries which causes the better growth of the pulmonary arteries, and simultaneously decreases the volume load on the functional single ventricle. [2][3][4] In order to fill the venous atrium, pulmonary artery pressure should be more than venous atrium to overcome the pulmonary vascular resistance which, in turn, increases the superior vena cava (SVC) pressure. 5,6 The difference in the SVC and inferior vena cava (IVC) pressure open up the venous collaterals to decompress SVC pressure 3,7-9 which, in turn, decreases the pulmonary blood flow and increases the systemic desaturation.…”

Section: Introductionmentioning

confidence: 99%

Post-Glenn Shunt Systemic Desaturation—Is Venovenous Collateral the Culprit?

Ponnana

Jyotsna

Kumar

2020

Indian Journal of Cardiovascular Disease in Women WINCARS

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After classic Glenn shunt or bidirectional cavopulmonary anastomosis, the reappearance or deepening of cyanosis may be due to systemic venous collateral channels. There are only few case reports on this issue in the present literature. Here, we present two cases that underwent bidirectional Glenn shunt, who later presented with cyanosis and desaturation and both of them were found to have venovenous collaterals.

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“…The classical Glenn shunt (CGS) involves connecting the superior vena cava (SVC) to the right pulmonary artery alone (4). A subsequent modification (the bidirectional Glenn shunt or BDGS; Figure 1) connects the SVC to both the right and left pulmonary arteries (7). Over time the quality of palliation provided by the CGS and BDGS deteriorates as the relative volume of venous return contributed by the SVC decreases with age.…”

Section: Introductionmentioning

confidence: 99%

Utility of the Bidirectional Glenn Shunt

Awori¹,

Mohamed²,

Mohamed³

2019

Ann Afr Surg.

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Background: Congenital heart disease (CHD) is a significant cause of childhood morbidity and mortality worldwide. Bidirectional Glenn Shunts (BDGS) form part of the surgical strategy used to treat CHD; no data exists on BDGS usage in the study locality. Methods: A 7-year retrospective, descriptive study was carried out at the Kenyatta National Hospital in Nairobi, Kenya, between 1 January 2006 and 31 December 2012. Results: Eleven BDGS were performed on 11 patients; 63.6% had tricuspid atresia, 27.3% had double outlet right ventricle and 9.1% had pulmonary atresia with intact ventricular septum. Conclusion: Further studies are warranted to identify factors contributing to the late performance of BDGS, poor post-operative follow-up and failure to perform FC.

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Physiological rationale for a bidirectional cavopulmonary shunt

Cited by 191 publications

References 43 publications

<![CDATA[<b>Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass?</b>]]>

<![CDATA[<b>Should the Bidirectional Glenn Operation be performed with or without cardiopulmonary bypass?</b>]]>

Post-Glenn Shunt Systemic Desaturation—Is Venovenous Collateral the Culprit?

Utility of the Bidirectional Glenn Shunt

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