Bidirectional Glenn Shunt: 170 Cases

Abstract

Between June 1997 and July 2000, 170 patients aged 0.5 to 20 years received a bidirectional Glenn shunt without the use of a temporary shunt or cardiopulmonary bypass. Arterial oxygen saturation rose from 78% ± 8.5% preoperatively to 90% ± 4.3% postoperatively. Hemodynamic studies showed a mean postoperative superior vena cava pressure of 13 ± 2 mm H2O. One patient had desaturation and the shunt was taken down, 5 required reexploration for bleeding, and 8 needed prolonged drainage of 9 to 19 days, 2 of whom had chylothorax. Hospital stay was 9.3 ± 3.5 days. There were 3 late operative deaths (1.8%) from low output syndrome. In 20 patients, bilateral bidirectional Glenn shunts were instituted. Three patients under-went a subsequent Fontan procedure without cardiopulmonary bypass. The bidirectional Glenn shunt remains an excellent palliative procedure as a preliminary step to a Fontan operation, or as an integral part of a Fontan or modified Fontan operation when the procedure is deferred because of age, weight, or cardiac malformations characterized by a hypoplastic right or left ventricle.