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Bidirectional Glenn and antegrade pulmonary blood flow: temporary or definitive palliation?
Ann Thorac Surg. 2008 Apr; 85(4):1389-95; discussion 1395-6.AT

Abstract

BACKGROUND

We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts.

METHODS

A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded.

RESULTS

No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 +/- 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%.

CONCLUSIONS

According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan.

Authors+Show Affiliations

Department of Pediatric Cardiac Surgery Marta e Milagros, Azienda di Rilievo Nazionale e di Alta Specializzazione, Ospedale Civico, Palermo, Italy. davidecalvaruso@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18355533

Citation

Calvaruso, Davide F., et al. "Bidirectional Glenn and Antegrade Pulmonary Blood Flow: Temporary or Definitive Palliation?" The Annals of Thoracic Surgery, vol. 85, no. 4, 2008, pp. 1389-95; discussion 1395-6.
Calvaruso DF, Rubino A, Ocello S, et al. Bidirectional Glenn and antegrade pulmonary blood flow: temporary or definitive palliation? Ann Thorac Surg. 2008;85(4):1389-95; discussion 1395-6.
Calvaruso, D. F., Rubino, A., Ocello, S., Salviato, N., Guardì, D., Petruccelli, D. F., Cipriani, A., Fattouch, K., Agati, S., Mignosa, C., Zannini, L., & Marcelletti, C. F. (2008). Bidirectional Glenn and antegrade pulmonary blood flow: temporary or definitive palliation? The Annals of Thoracic Surgery, 85(4), 1389-95; discussion 1395-6. https://doi.org/10.1016/j.athoracsur.2008.01.013
Calvaruso DF, et al. Bidirectional Glenn and Antegrade Pulmonary Blood Flow: Temporary or Definitive Palliation. Ann Thorac Surg. 2008;85(4):1389-95; discussion 1395-6. PubMed PMID: 18355533.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bidirectional Glenn and antegrade pulmonary blood flow: temporary or definitive palliation? AU - Calvaruso,Davide F, AU - Rubino,Antonio, AU - Ocello,Salvatore, AU - Salviato,Nicoletta, AU - Guardì,Diego, AU - Petruccelli,David F, AU - Cipriani,Adriano, AU - Fattouch,Khalil, AU - Agati,Salvatore, AU - Mignosa,Carmelo, AU - Zannini,Lucio, AU - Marcelletti,Carlo F, PY - 2006/01/23/received PY - 2008/01/01/revised PY - 2008/01/02/accepted PY - 2008/3/22/pubmed PY - 2008/4/17/medline PY - 2008/3/22/entrez SP - 1389-95; discussion 1395-6 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 85 IS - 4 N2 - BACKGROUND: We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts. METHODS: A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded. RESULTS: No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 +/- 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%. CONCLUSIONS: According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/18355533/Bidirectional_Glenn_and_antegrade_pulmonary_blood_flow:_temporary_or_definitive_palliation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)00022-2 DB - PRIME DP - Unbound Medicine ER -