bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. All patients were consid- ered less than “ideal” candidates for a Fontan . The bidirectional cavopulmonary shunt, like the classic. Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. Abstract. Objectives: The bidirectional cavopulmonary (Glenn) shunt is a commonly performed procedure for a variety of cyanotic congenital.

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When ventricular function was borderline, the first option was to go immediately towards Fontan completion.

Developmental assessment was done using either the Gesell developmental screening test [10]or developmental assessment for Indian sbunt [11]and Vineland social maturity scale [12]. Your comment will be reviewed and published at the journal’s discretion.

The bidirectional cavopulmonary shunt.

Whether opening of alternative venous channels for drainage or increased drainage through the azygous vein accounts for this observation remains unanswered. A novel trileaflet mechanical heart valve: An alternative to the total cavo-pulmonary circulation in patients with a functionally single ventricle. Persistent antegrade pulmonary blood flow post-Glenn does not alter post-Fontan outcomes in single-ventricle patients.

One of the important risk factors for death or takedown of the Fontan operation is dimensions of the right and dhunt pulmonary arteries, expressed as McGoon index. Little evidence indicates a benefit in delaying surgery after 6 months of age, except for patients with left atrial isomerism and interrupted inferior vena cava with azygous continuation to the superior vena cava.

Qs may vary from the value given here. There were no intraoperative or early within 7 days of procedure deaths. More on this topic Bilateral bidirectional Glenn: From a surgical perspective, although technically more difficult than shunh BCPS, the hemi-Fontan operation is reportedly well tolerated and makes a future Fontan procedure easier. Risk factors for prolonged length of stay after the stage 2 procedure in the Single Ventricle Reconstruction trial.

The bidirectional cavopulmonary Glenn shunt is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair.


Understanding Stage II Bidirectional Cavopulmonary Shunts

They used near-infrared spectroscopy to continuously monitor the oxyhemoglobin in the brain tissue. However, there is growing evidence that the very late results of Fontan circulation may be disappointing. All patients in the bypass group had additional procedures: The patients also had developmental assessment testing performed within a month after discharge Table 1.

In the other six patients, intraoperative SVC-right atrial temporary shunt was used with standard vena caval cannulas for shunting, with special efforts made to prevent air embolism. This is a non-parametric regression estimate of the relationship between the two variables, using locally weighted polynomial regression.

The question then arises to know whether excessive pulmonary blood flow due to APBF with ventricular volume overloading may, in part, explain this incidence of ventricular dysfunction.

Pressure measurements from catheters placed in femoral veins reflect common atrial filling pressure. The mean post-procedure oxygen saturation was This was a selected group of patients with good ventricular function who were supposed to become good candidates for a Fontan. Maybe it is due to the small number of patients. For each single-ventricle lesion, the sources of pulmonary and systemic blood flow primarily determine the initial palliative surgery.

Close mobile search navigation Article navigation. The mean age at operation was 3. Previous Section Next Section. But there is the occasional Glenn patient where you do the Glenn, and you are too desaturated in the operating room, then we will leave an extra source only for a need for oxygenation.

The mean transcranial pressure gradient in our patients was Usefulness of pulsatile bidirectional cavopulmonary shunt in high-risk Fontan patients.

The bidirectional cavopulmonary shunt.

All patients received cardioplegia. Patients lost to follow-up were not included in the analysis. J Thorac Cardiovasc Surg ; Venous obstruction and cerebral perfusion during experimental cardiopulmonary bypass. Others are only suitable for single-ventricle palliation strategies. Higher risk of oesophageal squamous cell carcinoma in achalasia: The procedure consists of stenting the ductus arteriosus and placing bilateral pulmonary artery bands. The former group of patients were at higher risk for death and transplant and usually had a Fontan completion at an older age.


Shunts contribute to additional volume loading on the single ventricle by bypassing the lungs and worsening cyanosis. Definitive palliation with cavopulmonary or aortopulmonary shunts for adults with single ventricle physiology.

Echocardiographic evaluation before bidirectional Glenn operation in functional single-ventricle heart disease: Usual bidirectionla to increase cerebral vasodilatation that, in cavpoulmonary, would increase effective pulmonary blood flow and systemic arterial oxygenation eg, hypoventilation, acidosis, decreasing alveolar oxygenationmay contribute to pulmonary vasoconstriction. If the final surgery is a lateral tunnel Fontan rather than an extracardiac conduit, the hemi-Fontan surgery makes stage III surgery easier.

Most often, it is performed under cardiopulmonary bypass CPBwith its biditectional complications and costs. Novel technique of bidirectional Glenn shunt without cardiopulmonary bypass. Regardless of previous surgery, in all types of stage II operations, the BCPS is created by dividing the SVC above the right atrium and anastomosing the SVC to the pulmonary artery, allowing for bidirectional or right and left flow of deoxygenated blood from the head and arms to the lungs, bypassing the heart.

But that is slightly over-simplistic because it is not as though everybody is great until you do the Fontan and then the clock starts ticking. Cardiac catheterization is necessary cavopulmonnary bidirectional Glenn procedure in single ventricle physiology.

Blood from the SVC was effectively drained into the right atrium. Comparatively, patients with greater than mild AVV regurgitation and cavkpulmonary than moderately reduced function postoperatively tend to have poor outcomes 43 Figure 7. One was leading an active, although limited, professional life; the other had severe psychiatric disorders. There are some preliminary answers to this question.