scholarly journals Decompression of superior vena cava during bidirectional Glenn shunt

2009 ◽  
Vol 12 (2) ◽  
pp. 146 ◽  
Author(s):  
Venugopal Kulkarni ◽  
Ravikiran Mudunuri ◽  
Krishnaprasad Mulavisala ◽  
RJagannath Byalal
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt

scholarly journals Decompression of superior vena cava during bidirectional Glenn shunt: A simple but risky technique

2012 ◽  
Vol 15 (1) ◽  
pp. 90 ◽  
Author(s):  
PraveenKumar Neema ◽  
Sethuraman Manikandan ◽  
SubrataK Singha ◽  
RameshChandra Rathod
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Bidirectional Glenn Shunt

A Modified Technique of Venoatrial Bypass in Bidirectional Glenn Shunt

1996 ◽  
Vol 4 (1) ◽  
pp. 23-24 ◽  
Author(s):  
Manisha Lal ◽  
Tek Singh Mahant
Keyword(s):  
Superior Vena Cava ◽  
Superior Vena ◽  
Venous Pressure ◽  
Vena Cava ◽  
Modified Technique ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Modified Method ◽  
Bidirectional Glenn Shunt ◽  
Facial Edema

Clamping of the superior vena cava, while constructing a bidirectional Glenn shunt in patients with a single superior vena cava, may lead to an unacceptable rise in proximal venous pressure. Between January 1993 and March 1994, 7 patients underwent bidirectional Glenn shunt at our institution. Of these 7, 4 had a single superior vena cava and required venoatrial bypass. This was carried out with interposition of a roller pump. Central venous pressure was maintained at 13 to 30 mm Hg (mean 23.5 mm Hg) and arterial pressure at 60 to 74 mm Hg (mean 64 mm Hg). Postoperatively, no facial edema or neuropsychological disturbance was detected. This modified method is more effective than simple venoatrial bypass and less extensive than a cardiopulmonary bypass.

scholarly journals Percutaneous salvage interventions in the Glenn circuit: a case series

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Aritra Mukherji ◽  
Sanjiban Ghosh ◽  
Jayita Nandi Das ◽  
Amitabha Chattopadhyay
Keyword(s):  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Superior Vena Cava Syndrome ◽  
Superior Vena ◽  
Vena Cava ◽  
Left Pulmonary Artery ◽  
Glenn Shunt ◽  
Bidirectional Glenn ◽  
Vena Cava Syndrome

Abstract Background In majority of children bidirectional Glenn shunt is a safe and efficacious procedure with minimal post-operative issues. Rarely, there may be dysfunction in the Glenn pathway due loss of anatomical integrity or derangements in normal physiological or hemodynamic milieu. We report 4 cases in the last 3 years (2016-2019) where complications in the Glenn circuit led to serious consequences requiring transcatheter interventions. Case presentation Two of our patients presented with frank features of superior vena cava syndrome. One of them had right Glenn anastomotic site narrowing leading to severe obstruction along with significant left pulmonary artery origin stenosis. The other child had excessive antegrade flow impeding normal Glenn flow leading to superior vena cava syndrome. The next child in our series was initially lost to follow-up after bidirectional Glenn surgery. Later on, this child was noted to have discontinuous left pulmonary artery with perfusion only to the right lung from the Glenn. The remaining child described in this series had developed a large tortuous venous collateral post Glenn shunt leading to severe cyanosis. All the above children needed prompt percutaneous interventions to revert back to their basal state. On follow-up, the benefit was sustained in all. Conclusions Percutaneous intervention procedures often provide a successful bailout option in various complicated situations post Glenn surgery with reasonable efficacy and safety.

NUMERICAL STUDY OF BIDIRECTIONAL GLENN WITH UNILATERAL PULMONARY ARTERY STENOSIS

2014 ◽  
Vol 14 (04) ◽  
pp. 1450056 ◽  
Author(s):  
XI ZHAO ◽  
YOUJUN LIU ◽  
JINLI DING ◽  
FAN BAI ◽  
XIAOCHEN REN ◽  
...  
Keyword(s):  
Shear Stress ◽  
Wall Shear Stress ◽  
Pulmonary Artery ◽  
Superior Vena Cava ◽  
Superior Vena ◽  
Vena Cava ◽  
Artery Stenosis ◽  
Patient Specific ◽  
Pulmonary Artery Stenosis ◽  
Bidirectional Glenn

Purpose: Hypoplastic left heart syndrome (HLHS) is a congenital heart disease and is usually associated with pulmonary artery stenosis. The superior vena cava-to-pulmonary artery (bidirectional Glenn) shunt is used primarily as a staging procedure to the total cava-to-pulmonary connection for single-ventricle complex. When HLHS coexists with pulmonary artery stenosis, the surgeons then face a multiple problem. This leads to high demand of optimized structure of Glenn surgery. The objective of this article is to investigate the influence of various anastomotic structures and the direction of superior vena cava (SVC) in Glenn on hemodynamics under pulse inflow conditions and try to find an optimal structure of SVC in Glenn surgery with unilateral pulmonary artery stenosis.Method: First, 3D patient-specific models were constructed from medical images of a HLHS patient before any surgery by using the commercial software Mimics, and another software Free-form was used to deform the reconstructed models in the computer. Four 3D patient-specific Glenn models were constructed: model-1 (normal Glenn), model-2 (lean the SVC back to the stenotic pulmonary artery), model-3 (lean the SVC towards the stenotic pulmonary artery), model-4 (add patch at junction of the SVC toward stenosis at pulmonary artery). Second, a lumped parameter model (LPM) was established to predict boundary conditions for computational fluid dynamics (CFD). In addition, numerical simulations were conducted using CFD through the finite volume method. Finally, hemodynamic parameters were obtained and evaluated.Results: It was showed that model-4 have relatively balanced vena cava blood perfusion into the left pulmonary artery (LPA) and right pulmonary artery (RPA), this may be due to less helical flow and the patch at junction of the SVC. Near stenosis of pulmonary artery, model-4 performed with the higher wall shear stress (WSS), which would benefit endothelial cell function and gene expression. In addition, results showed that model-4 performed with the lower oscillatory shear index (OSI) and wall shear stress gradient (WSSG), which would decrease the opportunity of vascular intimal hyperplasia.Conclusion: It is benefited that surgeons adds patch at junction of the SVC towards stenosis at pulmonary artery. These results can impact the surgical design and planning of the Glenn surgery with unilateral pulmonary artery stenosis.

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.

An Efficient Assisted Bidirectional Glenn Design With Lowered Superior Vena Cava Pressure for Stage-One Single Ventricle Patients

2021 ◽  
Vol 143 (7) ◽  
Author(s):  
Dongjie Jia ◽  
Matthew Peroni ◽  
Tigran Khalapyan ◽  
Mahdi Esmaily
Keyword(s):  
Superior Vena Cava ◽  
Single Ventricle ◽  
Superior Vena ◽  
Vena Cava ◽  
Bidirectional Glenn ◽  
Pulmonary Flow ◽  
Optimization Study ◽  
Shaped Nozzle ◽  
The Right ◽  
Brachiocephalic Veins

Abstract Recently, the assisted bidirectional Glenn (ABG) procedure has been proposed as an alternative to the modified Blalock–Taussig shunt (mBTS) operation for neonates with single-ventricle physiology. Despite success in reducing heart workload and maintaining sufficient pulmonary flow, the ABG also raised the superior vena cava (SVC) pressure to a level that may not be tolerated by infants. To lower the SVC pressure, we propose a modified version of the ABG (mABG), in which a shunt with a slit-shaped nozzle exit is inserted at the junction of the right and left brachiocephalic veins. The proposed operation is compared against the ABG, the mBTS, and the bidirectional Glenn (BDG) operations using closed-loop multiscale simulations. Both normal (2.3 Wood units-m2) and high (7 Wood units-m2) pulmonary vascular resistance (PVR) values are simulated. The mABG provides the highest oxygen saturation, oxygen delivery, and pulmonary flow rate in comparison to the BDG and the ABG. At normal PVR, the SVC pressure is significantly reduced below that of the ABG and the BDG (mABG: 4; ABG: 8; BDG: 6; mBTS: 3 mmHg). However, the SVC pressure remains high at high PVR (mABG: 15; ABG: 16; BDG: 12; mBTS: 3 mmHg), motivating an optimization study to improve the ABG hemodynamics efficiency for a broader range of conditions in the future. Overall, the mABG preserves all advantages of the original ABG procedure while reducing the SVC pressure at normal PVR.

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