Veno-venous shunt-assisted cavopulmonary anastomosis.

Abstract

OBJECTIVE:

The bidirectional Glenn shunt is commonly performed under cardiopulmonary bypass for conditions that lead to a single ventricle repair. We report our experience of bidirectional Glenn shunt done without cardiopulmonary bypass.

METHODS:

Between June 2007 and May 2009, 186 consecutive patients underwent off-pump bidirectional Glenn shunt for a variety of complex cyanotic congenital heart defects. Age ranged from four months to six years and the median weight was 11.17 kg (range 4.3 - 18). After systemic heparinization, the procedure was done by creating a temporary shunt between the innominate vein and the right atrium connected across a three way connector for de-airing. Fifty one patients had bilateral cavae. All cases underwent complete clinical neurological examination.

RESULTS:

No case required conversion onto cardiopulmonary bypass. Four patients (2.14%) died in the immediate postoperative period. The mean internal jugular venous pressure on clamping the decompressed superior vena cava was 24.69 +/- 1.81 mm Hg. There was no intra-operative hemodynamic instability and oxygen saturation was maintained at more than 70% throughout. Post Glenn shunt, the saturations improved to mid 80s. Seventy four cases had documented forward flow across the pulmonary valve. The mean duration of ventilation was 10.17 +/- 8.96 hours and there were no neurological complications. Six patients (3.22%) developed pleural effusions, 4 patients (2.15%) had nodal rhythm and 9 patients (4.83%) had superficial sternal wound infection.

CONCLUSIONS:

Our results show that off-pump bidirectional Glenn shunt can be done safely in patients not requiring associated intra-cardiac correction. It avoids cardiopulmonary bypass and its related complications, is economical and associated with excellent results. In our opinion, this is the largest series of off-pump bidirectional Glenn shunt in the literature.

• Authors: Pramod Reddy Kandakure, Anil Kumar Dharmapuram, Suresh Babu Kale, Vivek Babu, Nagarajan Ramadoss, Ramkinkar Shastri, Avinash Londhe, Ivatury Mrityunjaya Rao, Kona Samba Murthy
• Journal: Annals of pediatric cardiology (Ann Pediatr Cardiol) Vol. 3 Issue 1 Pg. 8-11 (Jan 2010) ISSN: 0974-5149 [Electronic] India
• PMID: 20814470 (Publication Type: Journal Article)