Abstract
A connection between the superior vena cava and the right pulmonary artery is known as Glenn’s shunt. Since the late 1950s, the Glenn’s shunt has been performed to improve pulmonary blood flow in patients with cyanotic congenital heart disease. Venous access to the right ventricle was complicated by the loss of continuity between the right atrium and superior vena cava consequent on the previous surgery [1]. The incidence of complete heart block following Glenn’s shunt is not known. Complete heart block may occur immediately after surgery or early in the postoperative period and also may occur many months or years after surgery. Implantation of epicardial leads was considered undesirable because of the previous thoracic surgery.
Highlights
A connection between the superior vena cava and the right pulmonary artery is known as Glenn’s shunt
We present a case of cyanotic heart disease, post Bidirectional Glenn’s shunt. with single ventricle and supravalvular pulmonary stenosis who had symptomatic complete heart block and required permanent pacemaker implantation
We describe a technique for transvenous permanent pacing in patients with a superior cavopulmonary connection performed with the Bidirectional Glenn operation using the conventional subclavian vein approach and pectoral placement of the generator
Summary
A connection between the superior vena cava and the right pulmonary artery is known as Glenn’s shunt. A superior vena cava connection to pulmonary artery (Glenn shunt) is currently the initial surgical step toward creating a total cavo-pulmonary connection (Fontan operation) in patients with a functionally univentricular heart. The superior cavo-pulmonary connection remains the definitive palliative procedure when completion of the total cavo-pulmonary anastomosis is deemed to be inappropriate These patients remain cyanosed with inferior vena cava flow returning to the systemic circulation. Surgical exploration at 12 years had demonstrated a functional single ventricle and supravalvar pulmonary stenosis At this operation a palliative Classic Blalock-Taussig’s shunt was created. Pre procedure selective venous angiogram was done initially revealed superior vena cava connected to right pulmonary artery (Figure 3).
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