Pramod Reddy Kandakure, Anil Kumar Dharmapuram, Suresh Babu Kale, Vivek Babu, Nagarajan Ramadoss, Ramkinkar Shastri, Avinash Londhe, Ivatury Mrityunjaya Rao, Kona Samba Murthy
Department of Pediatric Cardiac Surgery and Cardiac Anesthesiology, Innova Children's Heart Hospital, Secunderabad, India
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.
Kona Samba Murthy
Department of Paediatric Cardiac Surgery, Innova Children's Heart Hospital, Tarnaka, Secunderabad - 500 017, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
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