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Ann Thorac Surg 2005;80:976-981
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Appropriate Additional Pulmonary Blood Flow at the Bidirectional Glenn Procedure is Useful for Completion of Total Cavopulmonary Connection

^a Department of Cardiothoracic Surgery, Kobe Children’s Hospital, Kobe, Hyogo, Japan
^b Division of Cardiovascular, Thoracic, and Pediatric Surgery, Department of Cardiopulmonary and Vascular Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan

Accepted for publication March 21, 2005.

^_* Address reprint requests to Dr Yoshida, Department of Cardiothoracic Surgery, Kobe Children’s Hospital, 1-1-1 Takakuradai Suma-ku, Kobe, 654-0081, Japan (Email: yoshidamasa_kch{at}hp.pref.hyogo.jp).

Presented at the Poster Session of the Forty-first Annual Meeting of The Society of Thoracic Surgeons, Tampa, FL, Jan 24–26, 2005.

BACKGROUND: The role and effect of additional pulmonary blood flow at the time of bidirectional Glenn procedure (BDG) is controversial. We assessed our experiences to clarify the effects of controlled additional pulmonary blood flow on outcomes after BDG.

METHODS: Thirty-eight patients who underwent BDG (2.1 ± 2.1 years of age) were enrolled in this study. In group A (n = 29) additional pulmonary blood flow was controlled by the banding of the pulmonary trunk, or the previously created Blalock-Taussig shunt, to keep the central venous pressure equal to or less than 16 mm Hg at BDG. In group B (n = 9), BDG was the only source of pulmonary blood flow.

RESULTS: One operative death occurred in group B. In group A, 24 patients underwent total cavopulmonary connection (TCPC) 14 ± 6 months after BDG, and the remaining 5 patients are waiting for TCPC in good condition. In group B, 6 patients underwent TCPC 8 ± 7 months after BDG. One patient is awaiting TCPC and the remaining patient is considered unsuitable for TCPC. Cardiac catheterization performed in 32 patients showed significant decrease of pulmonary artery (Nakata) index from 307 ± 73 to 215 ± 45 mm²/m² after BDG in group B (p < 0.05). On the other hand, the Nakata index stayed in higher range from 316 ± 115 to 287 ± 74 mm²/m² in group A, and there was a significant correlation between the Nakata index and the percentage of its difference (Y = 40.823 – 0.144 X; n = 26, R = 0.740, p < 0.0001).

CONCLUSIONS: Appropriate additional pulmonary blood flow is useful for the completion of TCPC by means of suppressing the decrease in the size of the pulmonary artery, especially in patients with underdeveloped pulmonary arteries.

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