HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Salvatore Ocello Nicoletta Salviato Khalil Fattouch Salvatore Agati Carmelo Mignosa Lucio Zannini Carlo F. Marcelletti Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Calvaruso, D. F. Articles by Marcelletti, C. F. Search for Related Content PubMed PubMed Citation Articles by Calvaruso, D. F. Articles by Marcelletti, C. F. Related Collections Congenital - cyanotic

---

Original Articles: Pediatric Cardiac

Bidirectional Glenn and Antegrade Pulmonary Blood Flow: Temporary or Definitive Palliation?

^a Department of Pediatric Cardiac Surgery "Marta e Milagros," Azienda di Rilievo Nazionale e di Alta Specializzazione, Ospedale Civico, Palermo, Italy
^b Department of Cardiac Surgery, University of Palermo, Palermo, Italy
^c Department of Pediatric Cardiac Surgery, Ospedale S. Vincenzo, Taormina (ME), Italy
^d Department of Pediatric Cardiac Surgery, Istituto Gaslini, Ospedale Pediatrico, Istituto di Ricovero e Cura a Carattere Scientifico, Genova, Italy

Accepted for publication January 2, 2008.

^_* Address correspondence to Dr Calvaruso, A.R.N.A.S. Ospedale Civico, Palermo Pediatric Cardiac Surgery, Piazza Leotta, 4, Palermo, 90127, Italy (Email: davidecalvaruso{at}hotmail.com).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

Background: We sought to investigate the role of the bidirectional Glenn with antegrade pulmonary blood flow in the surgical history of children with univentricular hearts.

Methods: A series of 246 patients, from three joint institutions, having univentricular heart with restricted but not critical pulmonary blood flow received a bidirectional cavopulmonary shunt with additional forward pulmonary blood flow. All patients have been studied according to their progression, or not, to Fontan operation. Two hundred and eight (84.5%) patients underwent bidirectional cavopulmonary anastomosis as primary palliation. Twenty patients (8.1%) with previous pulmonary artery banding were also enrolled in the study. Patients who had received additional pulmonary blood flow through a previous systemic to pulmonary artery shunt for the critical pulmonary blood flow were excluded.

Results: No in-hospital death occurred. Follow-up was complete at 100%. Mean follow-up was 4.2 ± 2.8 years (range, 6 months to 7 years). During the observational period 73 (29.7%) patients, considered optimal candidates, underwent Fontan completion for increasing cyanosis and (or) hematocrit and (or) fatigue with exertion. Three patients expired after total cavopulmonary connection (3 of 73; 4.1% mortality rate). The remaining 173 (70.3%) patients are alive with initial palliation. All patients were still well palliated with an arterial oxygen saturation at rest about 90%.

Conclusions: According to our experience and results, bidirectional Glenn with antegrade pulmonary blood flow may be an excellent temporary palliation prior to a Fontan operation, which can be performed at the onset of symptoms. Bidirectional Glenn may also be the best possible palliation for a suboptimal candidate for Fontan.

This article has been cited by other articles:

				T. P. Graham Jr The Year in Congenital Heart Disease J. Am. Coll. Cardiol., October 28, 2008; 52(18): 1492 - 1499. [Full Text] [PDF]