(Circulation. 1995;92:294-297.)
© 1995 American Heart Association, Inc.
Articles |
Bidirectional Glenn
Is Accessory Pulmonary Blood Flow Good or Bad?
Presented in part at the 67th Scientific Sessions of the American Heart Association, Dallas, Tex, November 16, 1994, and published in abstract form (Circulation. 1994;90[pt 2]I-421).
From the Divisions of Cardiac Surgery and Cardiology, Children's Heart Institute, Children's Hospital-San Diego, Calif.
Correspondence to Richard D. Mainwaring, MD, 3030 Children's Way, Suite 310, San Diego, CA 92123.
Background The bidirectional Glenn (BDG) is frequently used in the staged surgical management of single ventricle patients. Controversy exists whether accessory pulmonary blood flow (APBF) sources should be left at the time of the BDG to augment systemic saturation or should be eliminated to reduce volume load of the ventricle. The present study was a retrospective review to assess the influence of APBF on outcome after the BDG.
Methods and Results Ninety-two patients have undergone BDG at our institute during the interval from 1986 through 1994. At the time of BDG, 40 patients had either a systemic-to–pulmonary artery shunt or patent right ventricular outflow tract as an additional source of pulmonary blood flow. Fifty-two patients had elimination of APBF. There were three operative deaths (two with and one without APBF) and four procedures (two in each group) that failed and required subsequent revision. Thus, there were 85 patients who underwent successful operation. Effusions (defined as chest tube drainage exceeding 7 days' duration) occurred in 8 of 85 patients; this complication was seen in 7 of 36 patients (19%) with APBF and 1 of 49 patients (2%) without APBF (P<.05). There were 11 deaths, including 6 patients (17%) with APBF, 2 patients (4%) without APBF, and 3 of the patients (75%) who had a failed BDG.
Conclusions The data suggest that morbidity and mortality are lower in patients in whom APBF is eliminated at the time of the BDG.
Key Words: shunts • ventricles • blood flow
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