Single-Stage versus Two-Stage Modified Fontan Procedure

2007 ◽  
Vol 15 (4) ◽  
pp. 327-331 ◽  
Author(s):  
Sukasom Attanavanich ◽  
Alisa Limsuwan ◽  
Suthep Vanichkul ◽  
Panuwat Lertsithichai ◽  
Montein Ngodngamthaweesuk
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Volume Overload ◽  
Single Stage ◽  
Two Stage ◽  
Bidirectional Glenn ◽  
Atrioventricular Valve Regurgitation ◽  
Bidirectional Glenn Shunt ◽  
Significant Difference ◽  
Before And After

We compared surgical outcomes of the single-stage and two-stage modified Fontan procedures to clarify clinical superiority. Of 28 children undergoing a modified Fontan procedure from October 1995 to October 2005, 15 had a 1-stage and 13 had a 2-stage operation. In the 2-stage group, pulmonary artery growth was evaluated before and after the first stage. Operative mortality was 26.6% in the 1-stage group and 0% in the 2-stage group. The benefits of a previous bidirectional Glenn shunt were decreased cyanosis and volume overload, but there was no significant difference in pulmonary artery growth reflected in pulmonary artery indices before and after the bidirectional Glenn procedure. Older children underwent a 2-stage modified Fontan procedure and had better outcomes in terms of lower mortality, improved oxygen saturation, decreased volume load, and less deterioration of atrioventricular valve regurgitation.

scholarly journals Use of Pericardial Patch Conduit in Bidirectional Glenn Shunt: An Innovative Technique

2020 ◽  
Vol 13 (1) ◽  
pp. 92-94
Author(s):  
Kazi Shariful Islam ◽  
Shahriar Moinuddin ◽  
Ankan Kumar Paul ◽  
Masud Alam
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Stenosis ◽  
Fontan Procedure ◽  
Left Pulmonary Artery ◽  
Intermediate Step ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Palliative Procedure ◽  
Bidirectional Glenn Shunt ◽  
Right Pulmonary Artery

Bidirectional Glenn Shunt is a palliative procedure in single ventricle or hypoplastic right ventricle, tricuspid atresia and pulmonary stenosis complex where definitive repair is not feasible as well as a intermediate step of Fontan procedure. It is done by anastomosing superior venacava with right pulmonary artery or conduit can be used. We were forced to do the anastomosis between superior venacava and left pulmonary artery using a conduit as anatomy wasn’t favorable. Due to unavailability of any recognized conduits we used autologous pericardium and created a conduit with it to carry out anastomosis. Post-operative results were satisfactory. Cardiovasc. j. 2020; 13(1): 92-94

Bidirectional Glenn Shunt for Complex Cyanotic Congenital Heart Disease

1995 ◽  
Vol 3 (2) ◽  
pp. 63-66
Author(s):  
Sushant Srivastava ◽  
Krishna Subramony Iyer ◽  
Rajesh Sharma ◽  
Anil Bhan ◽  
Bhabananda Das ◽  
...  
Keyword(s):  
Fontan Procedure ◽  
Fontan Operation ◽  
Vena Cava ◽  
Glenn Shunt ◽  
Group Iii ◽  
Bidirectional Glenn ◽  
Volume Load ◽  
Bidirectional Glenn Shunt ◽  
Group I ◽  
Group Ii

The bidirectional Glenn Shunt has been advocated for definitive or staged palliation of patients with a functional single ventricle and decreased pulmonary blood flow who are unsuitable for a Fontan operation. Between April 1990 and July 1994, 86 patients underwent bidirectional Glenn operation at the All India Institute of Medical Sciences in New Delhi. This operation was performed electively in 73 patients (group I), as a take-down for Fontan failure in 10 patients (group II), and to complement a two-ventricle repair in 3 patients in whom the right ventricle or the tricuspid valve was inadequate to handle the entire systemic venous return (group III). Fifty-five other procedures were performed in addition to the cavopulmonary shunt. The mean ICU stay was 2 days. There were 5 early deaths in group I, 6 in group II, and none in group III. Mean oxygen saturation at the time of discharge was 84.2% on room air. Follow-up ranged from 3 to 51 months. The bidirectional Glenn shunt was definitive palliation in 9 patients with azygos or hemiazygos continuation of the inferior vena cava. In the remaining patients, a corrective procedure is planned only if there is evidence of failure of palliation or ideal criteria for the Fontan procedure are met. Only 3 patients from group I have therefore undergone subsequent conversion to a Fontan circulation. The bidirectional Glenn shunt provides excellent relief of cyanosis, does not volume load the heart, and possibly lowers the risk of a subsequent Fontan operation. Timely take-down of a failed Fontan procedure is imperative for successful salvage.

CFD Modeling of Blood Flow in a Bidirectional Glenn Shunt and a Combined Bidirectional Glenn and Blalock-Taussig Shunt

2021 ◽  
Author(s):  
Chunhui Wang ◽  
Ramesh K. Agarwal
Keyword(s):  
Blood Flow ◽  
Shear Stress ◽  
Wall Shear Stress ◽  
Pulmonary Artery ◽  
Pulmonary Arteries ◽  
Patient Specific ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
Blalock Taussig Shunt

Abstract Cyanosis or “Blue Baby Syndrome,” is an infant disorder which affects the newly born babies whose skins turn blue or purple because of lack of required blood flow between heart and lung due to pulmonary vascular blockage. Many patients may also have stenosis in vessels. If there is not enough blood flow from heart to the lung, lack of oxygen will cause platelet aggregation and coagulation resulting in elevated wall shear stress which may potentially result in death. In order to address the congenital defect and increase blood flow and oxygen saturation levels within the blood pumping system, a biological shunt is usually planted between innominate veins and left and right pulmonary arteries. The well-known examples are Blalock-Taussig shunt (BT shunt) between right ventricle and pulmonary artery and bidirectional Glenn shunt (BGS) between innominate veins and pulmonary arteries. The goal of this paper is to study the hemodynamics of BGS, wherein the blood flow goes through superior vena cava (SVC), innominate and subclavian veins and pulmonary arteries. In another simulation, Blalok-Taussing shunt (BTS) is also included along with the BGS. In BTS, the blood directly flows between innominate and pulmonary artery. The models are created with SolidWorks and Blender software based on real patient aorta model parameters. The commercial CFD software ANSYS is used to simulate the blood flow. CFD simulations are performed for blood flow (1) in patient specific aorta model without BGS and (2) in patient specific model with both BGS and BTS. The results for distribution of pressure, velocity and wall shear stress are obtained and analyzed to evaluate the performance of BGS alone and with both BGS and BTS. The computations are compared with limited available clinical data. This study demonstrates how CFD can be effectively utilized in the design of medical devices such as BGS and BTS and to improve the clinical outcomes in patients.

scholarly journals Fontan procedure following bidirectional Glenn shunt for high risk patients

1991 ◽  
Vol 17 (2) ◽  
pp. A33 ◽  
Author(s):  
Richard A Jonas ◽  
Nancy D. Bridges ◽  
Frank L. Hanley ◽  
John E. Mayer ◽  
Aldo R. Castaneda
Keyword(s):  
High Risk ◽  
Fontan Procedure ◽  
Glenn Shunt ◽  
High Risk Patients ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
Risk Patients

scholarly journals Fontan completion after Norwood with bidirectional Glenn shunt: their haemodynamics and pulmonary artery configuration

2012 ◽  
Vol 15 (2) ◽  
pp. 204-208 ◽  
Author(s):  
K. Umezu ◽  
Y. Harada ◽  
T. Sakamoto ◽  
Y. Maekawa ◽  
K. Takigiku ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt

Primary central pulmonary artery plasty for right atrial isomerism with pulmonary coarctation

2021 ◽  
pp. 021849232110452
Author(s):  
Motonori Ishidou ◽  
Keiichi Hirose ◽  
Akio Ikai ◽  
Kisaburo Sakamoto
Keyword(s):  
Pulmonary Artery ◽  
Fontan Procedure ◽  
Pulmonary Arteries ◽  
Pulmonary Atresia ◽  
Right Atrial ◽  
Bidirectional Cavopulmonary Shunt ◽  
Significant Difference ◽  
Central Pulmonary Artery ◽  
Right Isomerism ◽  
Cavopulmonary Shunt

Objective Patients with unbalanced pulmonary artery growth resulting from pulmonary coarctation are considered unsuitable candidates for the Fontan procedure. Particularly, patients with right isomerism pose a challenge. We aimed to investigate the use of primary central pulmonary artery plasty at initial palliation in patients with right isomerism. Methods We recruited 34 right isomerism patients with pulmonary atresia and pulmonary coarctation who underwent modified Blalock-Taussig shunt with or without primary central pulmonary artery plasty between 1998 and 2014. We classified them into the primary central pulmonary artery plasty (group P) and no primary central pulmonary artery plasty (group N) groups. We retrospectively analyzed reintervention for pulmonary artery after initial palliation, difference in size between the left and right pulmonary arteries, overall survival, success of the Fontan procedure. Results The group P and group N included 25 and 9 patients, respectively. Five (20%) and six (67%) patients in group P and group N, respectively, required reintervention for pulmonary artery after initial palliation ( p = 0.017). No patient underwent reintervention for the pulmonary artery before bidirectional cavopulmonary shunt in group P. There was a significant difference in the bilateral pulmonary artery size balance between the groups before bidirectional cavopulmonary shunt ( p = 0.041). The two-lung Fontan procedure was successful in 14 (56%) and 1 (11%) patient in group P and group N. Conclusion Primary central pulmonary artery plasty may contribute toward improving the balance in the size of the PA and preclude the need for reintervention for PA.

Echocardiographic Diagnosis of Congenital Arterial Catheter Function Changes

2021 ◽  
Vol 11 (6) ◽  
pp. 1633-1641
Author(s):  
Dan Shen ◽  
Jie Li ◽  
Li Fan
Keyword(s):  
Pulmonary Artery ◽  
Transthoracic Echocardiography ◽  
Systolic Pressure ◽  
Arterial Catheter ◽  
Therapeutic Effects ◽  
Closure Rate ◽  
Descending Aorta ◽  
Significant Difference ◽  
Before And After ◽  
Occlusion Technique

Arterial catheter is physiological flow channel between pulmonary artery and descending aorta in fetal circulation. Most right heart blood flow through artery catheter into descending aorta during embryo period. Most term neonates are usually stopped after fetal delivery. Functional closure occurs in 48 h after birth, while 88% should be closed completely at 8 weeks after birth. There was no significant difference between PDA occlusion technique guided by transthoracic echocardiography and conventional funnel PDA closure rate, total closure rate, long term closure rate, pulmonary systolic pressure before surgery and pulmonary artery pressure difference before and after operation (P < 0.05). Conversely, under similar therapeutic effects, funnel type PDA closure guided by transthoracic echocardiography has advantages such as shorter anesthesia time, less total ray volume and contrast agent, lower hospitalization expense and fewer complications. Therefore, through transthoracic echocardiography guidance delivery of order vein approach interventional closure therapy funnel type PDA especially suitable for children, worthy of clinical application.

scholarly journals A new technique to simplify the Fontan procedure after a previous bidirectional Glenn shunt

1993 ◽  
Vol 106 (3) ◽  
pp. 569-570 ◽  
Author(s):  
Mukundan Seshadri ◽  
B.R. Jagaannath ◽  
A.S. Koppula ◽  
R. Desai ◽  
K.R. Balakrishnan
Keyword(s):  
Fontan Procedure ◽  
New Technique ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt ◽  
A New Technique

scholarly journals Mortality and Recovery of Renal Function in Acute Kidney Injury Patients Treated with Prolonged Intermittent Hemodialysis Sessions Lasting 10 versus 6 Hours: Results of a Randomized Clinical Trial

2018 ◽  
Vol 2018 ◽  
pp. 1-10
Author(s):  
Bianca Ballarin Albino ◽  
Mariele Gobo-Oliveira ◽  
André Luís Balbi ◽  
Daniela Ponce
Keyword(s):  
Clinical Trial ◽  
Acute Kidney Injury ◽  
Renal Function ◽  
Kidney Injury ◽  
Volume Overload ◽  
Complete Recovery ◽  
Treatment Discontinuation ◽  
Intermittent Hemodialysis ◽  
Significant Difference ◽  
Before And After

Purpose. This trial aimed to compare mortality and recovery of renal function in acute kidney injury (AKI) patients treated with different durations of prolonged hemodialysis (PHD) sessions (6 h versus 10 h). Methodology. We included patients with sepsis-associated AKI, >18 years, who are in use of a norepinephrine (lower than 0.7 ucg/kg/min). Results. One hundred and ninety-four patients were treated with 531 sessions of PHD (G1=104 and G2=90 patients). The two groups were similar in age and SOFA. There was no significant difference in hypotension, hypokalemia, and anticoagulation during PHD sessions. The two groups showed differences in filter clotting, hypophosphatemia, and treatment discontinuation (12.3 versus 23.1%, p=0.002; 15.5 versus 25.8%, p=0.005; and 7.9 versus 15.6%, p=0.008, respectively). There was no difference in fluid balance (FB) before and after PHD sessions. Death and complete recovery of renal function were similar (81.3 versus 82.2%, p=0.87 and 21 versus 31.2%, p=0.7, respectively). At logistic regression, the positive FB before and after dialysis was identified as risk factor for death, while volume overload after three PHD sessions and predialysis creatinine were negatively associated with recovery of renal function in 28 days. Conclusion. There was no difference in the mortality and recovery of renal function of AKI patients submitted to different durations of PHD and sessions lasting 10 h presented higher filter clotting, hypophosphatemia, and treatment discontinuation. ISRCTN Registry number is ISRCTN33774458.

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