Abstract
The bidirectional superior cavopulmonary anastomosis is an important intermediate palliation in patients with a structurally or functionally univentricular heart. There is an increasing trend to perform this anastomosis without cardiopulmonary bypass. In this review, we present our preferred technique of performing this operation in a safe, simple, inexpensive and reproducible manner.
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Glenn WW. Circulatory bypass of the right side of the heart IV: Shunt between superior vena cava and distal right pulmonary artery; report of clinical application. N Engl J Med 1958;259:117–120.
MacIver RH, Stewart RD, Backer CL, Mavroudis C. Results with continuous cardiopulmonary bypass for the bidirectional cavopulmonary anastomosis. Cardiol Young 2008;18:147–152.
Lamberti JJ, Spicer RL, Waldman JD, et al. The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg 1990;100:22–29.
Lal M, Mahant TK. A modified technique of venoatrial bypass in bidirectional Glenn shunt. Asian Cardivasc Thorac Ann 1996;4:23–25.
Murthy KS, Coelho R, Naik SK, Punnoose A, Thomas W, Cherian KM. Novel techniques of bidirectional Glenn shunt without cardiopulmonary bypass. Ann Thorac Surg 1999;67:1771–1774.
Villagra F, Gomez R, Ignacio Herraiz J, Larraya FG, Moreno L, Sarrais P. The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: a safe and advisable technique. Rev Esp Cardiol 2000;53:1406–1409.
Liu J, Lu Y, Chen H, Shi Z, Su Z, Ding W. Bidirectional Glenn procedure without cardiopulmonary bypass. Ann Thorac Surg 2004;77:1349–1352.
Jahangiri M, Keogh B, Shinebourne EA, Lincoln C. Should the bidirectional Glenn procedure be performed through a thoracotomy without cardiopulmonary bypass? J Thorac Cardiovasc Surg 1999;118:367–368.
Tireli E, Basaran M, Kafali E, et al. Peri-operative comparison of different transient external shunt techniques in bidirectional cavo-pulmonary shunt. Eur J Cardiothoracic Surg 2003;23:518–524.
Luo XJ, Yan J, Wu QY, Yang KM, Xu JP, Liu YL. Clinical application of bidirectional Glenn shunt with off-pump technique. Asian Cardiovasc Thorac Ann 2004;12:103–106.
Hussain ST, Bhan A, Sapra S, Juneja R, Das S, Sharma S. The bidirectional cavopulmonary (Glenn) shunt without cardiopulmonary bypass: is it a safe option? Interact Cardiovasc Thorac Surg 2007;6:77–82.
Azzolina G, Eufrate S, Pensa P. Tricuspid atresia: experience in surgical management with a modified cavopulmonary anastomosis. Thorax 1972;27:111–115.
Calvaruso DF, Rubino A, Ocello S, Salviato N, et al. Bidirectional Glenn and antegrade pulmonary blood flow: temporary or definitive palliation? Ann Thorac Surg 2008;85:1389–1396.
Shivaprakasha K, Rameshkumar I, Kumar RK, et al. New technique of right heart bypass in congenital heart surgery with autologous lung as oxygenator. Ann Thorac Surg 2004;77:988–993
Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: a report by the American Society of Anesthesiologist Task Force on Preoperative Fasting. Anesthesiology 1999;90:896–905.
Phornphutkul C, Rosenthal A, Nadas AS, Berenberg W. Cerebrovascular accidents in infants and children with cyanotic congenital heart disease. Am J Cardiol 1973;32:329–334.
Tempe DK, Virmani S. Coagulation abnormalities in patient with cyanotic congenital heart disease. J Cardiothorac Vasc Anesth 2002;16:752–765.
Rivenes SM, Lewin MB, Stayer SA, et al. Cardiovascular effects of sevoflurane, isoflurane, halothane, and fentanyl-midazolam in children with congenital heart disease: an echocardiographic study of myocardial contractility and haemodynamics. Anesthesiology 2001:94:223–229.
Morray JP, Lynn AM, Stamm SJ, Herndon PS, Kawabori I, Stevenson JG. Hemodynamic effects of ketamine in children with congenital heart disease. Anesth Analg 1984;63:895–899.
Schuller JL, Bovill JG. Severe reduction in arterial to end-tidal PCO2 differences following unilateral pulmonary artery occlusion in a child with pulmonary hypertension. Anesth Analg 1989;68:792–794.
Fletcher R. The relationship between arterial to end-tidal PCO2 differences and hemoglobin saturation in patients with congenital heart disease. Anesthesiology 1991;75:210–216.
Redington AN, Penny D, Shinebourne EA. Pulmonary blood flow after total cavopulmonary shunt. Br Heart J 1991;65:213–217.
Cloutier A, Ash JM, Smallhorn JF, et al. Abnormal distribution of pulmonary blood flow after the Glenn shunt or Fontan procedure: risk factor of development of arteriovenous fistulae. Circulation 1985;72:471–479.
Berdat PA, Belli E, Lacour-Gayet F, Planch’e C, Serraf A. Additional pulmonary blood flow has no adverse outcome after bidirectional cavopulmonary anastomosis. Ann Thorac Surg 2005;79:29–36.
Bradley SM, Simsic JM, Mulvihill DM. Hyperventilation impairs oxygenation after bidirectional superior cavopulmonary connection. Circulation 1998;98:II372–376.
Gross GJ, Jonas RA, Castaneda AR, Hanley FL, Mayer JE Jr, Bridges ND. Maturational and hemodynamic factors predictive of increased cyanosis after bidirectional cavopulmonary anastomosis. Am J Cardiol 1994;74:705–709.
Gamillscheg A, Zobel G, Urlesberger B, et al. Inhaled nitric oxide in patients with critical pulmonary perfusion after Fontan type procedures and bidirectional Glenn anastomosis. J Thorac Cardiovasc Surg 1997;113:435–442.
Brett SJ, Chambers J, Bush A, Rosenthal M, Evans TW. Pulmonary response of normal human subjects to inhaled vasodilator substances. Clin Sci (Lond) 1998;95:621–627.
Forbes TJ, Rosenthal GL, Reul GR Jr, Ott DA, Feltes TF. Risk factors for life-threatening cavopulmonary thrombosis in patients undergoing bidirectional superior cavopulmonary shunt: an exploratory study. Am Heart J 1997; 134: 865–871.
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Talwar, S., Sharma, P., Kumar, T.K.S. et al. Bidirectional superior cavo-pulmonary anastomosis without cardiopulmonary bypass. Indian J Thorac Cardiovasc Surg 24, 269–276 (2008). https://doi.org/10.1007/s12055-008-0061-x
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DOI: https://doi.org/10.1007/s12055-008-0061-x