Bilateral Bidirectional Glenn Anastomosis in an Adult Patient with Aneurysmal Degeneration after an Original Blalock-Taussig Shunt

We reviewed the management of 6 cases of chylothorax (5 male, 1 female; 1-12 years old) following 500 cardiothoracic procedures during January 2004- December 2006 at National Institute of Cardiovascular Diseases, Dhaka. Results: The surgical procedures preceding the occurrence of lymph leak included ligation of PDA in 3 patients (50%), modified Blalock-Taussig Shunt in 2 cases (33.33%), bidirectional Glenn shunt in 1 case (16.67%). A protocol for management of postoperative chylothorax was applied for all patients. In this protocol, non-surgical management was always the first line of treatment for patients with postoperative chylothorax in the form of intercostal tube drainage and diet modification using either medium-chain triglycerides (MCT). All of our patients responded to conservative therapy. Conclusions: Conservative management of postoperative chylothorax should be the first line of treatment in postoperative chylothorax either by MCT diet alone or (in case of failure) to be followed by TPN and complete bowel rest. DOI: 10.3329/bmj.v36i2.3610 Bangladesh Medical Journal 36(2) 2007 42-43

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

10.1115/fedsm2021-65102 ◽

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.

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