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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The Fontan procedure particularly its last modification using an extracardiac conduit can be carried out with a low early risk and yields satisfactory mid-term results. There are several technical advantages to cavopulmonary shunt when compared with other Fontan modifications. Comparison of hemodynamics between Norwood procedure and systemic-to-pulmonary artery shunt for single right ventricle patients.

The need for individual consent was waived. Cerebral effects in superior vena caval obstruction: Figure 8 Timing of atrioventricular valve repair. Among these six patients, four had a satisfactory clinical palliation in two of them, an additional aortopulmonary shunt had been performed during the interim period. Catheters placed in the right atrium directly measure common atrial pressure. For each single-ventricle bidirectionl, the sources of pulmonary and systemic blood flow primarily determine the initial palliative surgery.

Factors influencing survival in patients undergoing the bidirectional Glenn anastomosis. This superior cavopulmonary connection is an intermediate step, both anatomically and physiologically, between initial palliative bidirwctional and the final stage III Fontan repair. Developmental assessment was done using either the Gesell developmental screening test [10]or developmental assessment for Indian babies [11]and Vineland social maturity scale [12].

Nurses must understand the pertinent anatomy and physiology and recognize postoperative complications early in order to reduce morbidity. They undergo a sequence of operations during the first few years of life that ultimately result in pulmonary blood flow dependent on venous return without a subpulmonary ventricle.

Oxford University Press is a department of the University of Oxford.


The pericardium was opened and after assessing the cardiac anatomy, direct pulmonary artery PA pressure was taken in all patients. However, there is growing evidence that the very late results of Fontan circulation may be disappointing. Figure 6 Hemi-Fontan procedure. I mean, I have a couple of other thoughts having had the opportunity to read the manuscript. The characteristics of patients, diagnosis, procedures and follow-ups are given bidirectinal table 2.

Understanding Stage II Bidirectional Cavopulmonary Shunts

This suggests that delaying Fontan completion as long as possible may not impair the results of this procedure. Hybrid group has equivalent survival but higher pulmonary artery reintervention rate. The average period of postoperative ventilation required was 5. Our results show that in selected patients, bidirectional Glenn operation without cardiopulmonary bypass is a safe procedure.

The mean age at operation was 3. Search for related content.

The bidirectional cavopulmonary shunt.

Were there other patients who only got a bidirectional Glenn during that time period? Negative-pressure ventilation achieved with early extubation increases pulmonary blood flow in BCPS physiology.

The former group of patients cavopulmonqry at higher risk for death and transplant and usually had a Fontan completion at an older age. Previous Section Next Section. Compared with older infants, patients bidiretional BCPS who are less than 4 months old tend to be more cyanotic immediately after surgery with higher central venous pressure; however this condition tends to normalize during a period of days.

Results following Fontan completion were satisfactory no mortality and no major complication after a median follow-up of 7 years. Dysrhythmias after the modified Fontan procedure.

The cavopulmonary shunt is an excellent palliative procedure when right atrium-pulmonary artery connection modified Fontan must be deferred because of age, weight, or anatomic considerations. And in the other ones that were less favourable, you did an isolated Glenn with no extra source of pulmonary blood flow? Ideal outcomes for BCPS patients depend on adequate function of the ventricle and the AVV, no systemic outflow tract obstruction, minimal pulmonary artery obstruction, unobstructed pulmonary venous return, and no venous or arterial collaterals causing important shunts.


When ventricular function was very good, we tended to place another shunt. In the 11 other patients, additional interventions were performed during the interim period between BCPS and Fontan completion and included: Outcome after a “perfect” Fontan operation.

Understanding Stage II Bidirectional Cavopulmonary Shunts

Kogan et al 28 postulated that risk factors for prolonged chest drainage and longer hospitalization were due to elevated central venous pressure and a high transpulmonary gradient SVC pressure – common atrial pressure. There was no early or late mortality following Fontan completion. The use of a shunt with two standard right-angle cannula from the SVC or the innominate vein to the contralateral pulmonary artery was reported by Murthy et al.

Reprinted from Bando et al, 32 copyrightwith permission from Elsevier. Oxford University Press is a department of the University of Oxford.

The conduct of this operation without CPB can be associated with significant elevation of the proximal superior vena caval SVC pressure that may lead to neurological damage.

All these patients had adequate atrial septal defects ASD and no atrioventricular valve regurgitation. Pressure measurements from central venous catheters placed in the neck after BCPS providing there is no obstruction reflect the pressure of the pulmonary arteries, commonly referred to as Glenn pressure.

The bidirectional cavopulmonary Cavopjlmonary shunt BDG is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair [1]. One patient developed pulmonary artery hypertension and died 23 months later due to cardiac arrest. Additional studies 1526 indicated that when the BCPS was performed in infants less than 4 months old, SVC pressures were higher postoperatively and patients had lower oxygen saturations.

J Thorac Cardiovasc Surg ;