Commentary: The bidirectional Glenn procedure can be useful in palliating late presenting patients with complex congenital heart disease

The authors successfully utilize the bidirectional Glenn procedure to palliate late presenting, cyanotic patients with complex congenital heart disease. Additional information regarding preoperative diagnostic testing would be helpful. There is little information regarding patient screening and selection for the procedure. The short term results are satisfactory, however, mid-term and longer follow-up data is lacking. The treatment algorithm suggested by the report might be useful in other settings.

Quick atrial access by subxiphoid approach in extracorporeal cardiopulmonary resuscitation after bidirectional Glenn procedure

Bidirectional Glenn procedure outcomes are very good; therefore, extracorporeal membrane oxygenation use as extracorporeal cardiopulmonary resuscitation is uncommon. We describe a 13-month-old female who required extracorporeal cardiopulmonary resuscitation for ventricular tachycardia provoked by transient myocarditis 6 months post-bidirectional Glenn procedure. After extracorporeal membrane oxygenation induction with cannulation on the cervical vessels, small skin incision was created on the subxiphoid area without sternotomy and the atrium was cannulated. With adequate venous drainage and ventricular unloading, ventricular tachycardia eventually converted to sinus rhythm. The patient withdrew from extracorporeal membrane oxygenation and was discharged successfully. Our results suggest that for successful post-bidirectional Glenn extracorporeal cardiopulmonary resuscitation, quick atrial access and ventricular unloading are essential.