Bidirectional Glenn Shunt for Complex Cyanotic Congenital Heart Disease

Abstract

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.