Bidirectional Glenn Procedure for the Treatment of Complex Cyanotic Congenital Heart Diseases_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANGWei-min ,  ZHANGJing , WUZu-kai , BAIJin , 阿布都沙拉木

Department of Cardiac Surgery, People's General Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, P. R. China;

Corresponding author：

ZHANGJing, Email: zhangjing893@hotmail.com

Keywords：

Congenital heart disease; Cyanosis; Bidirectional Glenn procedure

DOI：

10.7507/1007-4848.20140137

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To summarize our clinical experience of bidirectional Glenn procedure (BGP) for the treatment of complex cyanotic congenital heart disease (CHD). Methods Clinical data of 68 patients with complex cyanotic CHD who underwent BGP in People's General Hospital of Xinjiang Uygur Autonomous Region from January 2007 to December 2012 were retrospectively analyzed. There were 40 male and 28 female patients with their average age of 3.9 years (range, 3 months to 22 years) and body weight of 6.2-53.0 (13.6±8.5)kg. Preoperative diagnosis included tricuspid atresia in 20 patients, single ventricle (SV) in 11 patients, double outlet right ventricle in 10 patients, complete transposition of great arteries in 7 patients, tricuspid stenosis in 5 patients, pulmonary atresia in 5 patients, corrected transposition of great arteries in 4 patients, tetralogy of Fallot in 4 patients and Ebstein's anomaly in 2 patients. Among them, there were 14 patients with dextrocardia or dextroversion of the heart, 2 patients with SV and pulmonary hypertension after pulmonary artery banding, and 1 complete transposition of great arteries patient after aortopulmonary shunt. Twenty-three patients received BGP under cardiopulmonary bypass (CPB) and 45 patients received BGP without CPB. Results Two patients died postoperatively, including 1 patient with severe low cardiac output syndrome (LCOS) and another patient with pulmonary infection. Postoperative pulse oximetry oxyhemoglobin saturation (SpO₂, 89.3%±7.4%) was significantly higher than preoperative SpO₂ (66.8%±11.8%, P < 0.05). In 53 patients, postoperative SpO₂ was more than 10% higher than preopera-tive SpO₂. Postoperative hematocrit (0.40±0.07) was significantly lower than preoperative hematocrit (0.49±0.11, P < 0.05). Postoperative complications included pleural effusion in 16 patients (23.5%), chylothorax in 7 patients (10.3%), LCOS in 5 patients (7.4%), arrhythmias in 4 patients (5.9%), and pneumothorax in 1 patient (1.5%), who were all cured after appropriate treatment. Fifty-five patients were followed up for 9 months to 6 years after discharge with satisfactory clinical results. All anastomoses remained patent without stenosis or thrombosis. Four patients successfully received total cavopulmonary connection 2 to 5 years after discharge. Conclusion BGP is safe and reliable for patients with complex cyanotic CHD who cannot undergo anatomic correlation or one-stage repair.

Citation： ZHANGWei-min, ZHANGJing, WUZu-kai, BAIJin. Bidirectional Glenn Procedure for the Treatment of Complex Cyanotic Congenital Heart Diseases. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(4): 482-485. doi: 10.7507/1007-4848.20140137 Copy

1.	Yuan SM, Jing H. Palliative procedures for congenital heart defects. Arch Cardiovasc Dis, 2009, 102 (6/7):549-557.
2.	周诚, 董念国, 杜心灵, 等.姑息性手术在复杂先天性心脏病患者中的应用.中国胸心血管外科临床杂志, 2012, 19 (5):494-497.
3.	Yamauchi H, Imura H, Maruyama Y, et al. Evolution of staged approach for Fontan operation. J Nippon Med Sch, 2002, 69 (2):154-159.
4.	Alsoufi B, Manlhiot C, Awan A, et al. Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation. Eur J Cardiothorac Surg, 2012, 42 (1):42-49.
5.	Wolff D, van Melle JP, Ebels T, et al. Trends in mortality (1975-2011) after one-and two-stage Fontan surgery, including bidirectional Glenn through Fontan completion. Eur J Cardiothorac Surg, 2014, 45 (4):602-609.
6.	Petrucci O, Khoury PR, Manning PB, et al. Outcomes of the bidirec-tional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg, 2010, 139 (3):562-568.
7.	Lapar DJ, Mery CM, Peeler BB, et al. Short and long-term outcomes for bidirectional glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg, 2012, 94 (1):164-170.
8.	Fujii Y, Sano S, Kotani Y, et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg, 2009, 87 (2):562-570.
9.	Stocker CF, Shekerdemian LS, Horton SB, et al. The influence of bypass temperature on the systemic inflammatory response and organ injury after pediatric open surgery:a randomized trial. J Thorac Cardiovasc Surg, 2011, 142 (1):174-180.
10.	Sitniakowsky LS, Later AF, van de Watering LM, et al. The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure. Transfus Med, 2011, 21 (4):236-246.
11.	Liu JF, Lu YA, Chen HW, et al. Bidirectional glenn procedure without cardiopulmonary bypass. Ann Thorac Surg, 2004, 77 (4):1349-1352.
12.	Bhan A. Off-pump bi-directional Glenn shunt:How I do it? Ann Pediatr Cardiol, 2008, 1 (2):131-134.
13.	Hussain A, Saleem K, Inam-Ullah I, et al. Bidirectional glenn shunt without cardiopulmonary bypass. J Coll Physicians Surg Pak, 2009, 19 (11):682-685.
14.	陈海生, 刘盛华, 何勇, 等.非体外循环双向Glenn分流术治疗紫绀型复杂先天性心脏病.中国胸心血管外科临床杂志, 2009, 16 (2):146-147.
15.	Lapar DJ, Mery CM, Peeler BB, et al. Short and long-term outcomes for bidirectional glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg, 2012, 94 (1):164-171.
16.	Agarwal HS, Churchwell KB, Doyle TP, et al. Inhaled nitric oxide use in bidirectional Glenn anastomosis for elevated Glenn pressures. Ann Thorac Surg, 2006, 81 (4):1429-1434.
17.	岑坚正, 庄建, 陈欣欣, 等.双向Glenn手术治疗儿童功能性单心室68例分析.中华外科杂志, 2007, 45 (12):812-814.
18.	Hussain A, Arfi AM, Hussamuddin M, et al. Comparative outcome of bidirectional Glenn shunt in patients with pulmonary vascular resis-tance>3.5 woods units versus < 3.5 woods units. Am J Cardiol, 2008, 102 (7):907-912.
19.	刘迎龙, 于存涛, 魏波, 等.非体外循环下行上腔静脉-肺动脉双向分流术的治疗体会.中华小儿外科杂志, 2003, 24 (3):218-220.
20.	丁芳宝, 梅举, 邹良建, 等.非体外循环下有搏动性双向Glenn手术治疗复杂先天性心脏病.中国胸心血管外科临床杂志, 2005, 12 (1):46-47.
21.	Calvaruso DF, Rubino A, Ocello S, et al. Bidirectional glenn and antegrade pulmonary blood flow:temporary or definitive palliation? Ann Thorac Surg, 2008, 85 (4):1389-1396.
22.	吴淑群, 黄萍.复杂性先天性心脏病手术后乳糜胸的治疗体会.心血管康复医学杂志, 2006, 15 (1):40-41.
23.	Kaulitz R, Hofbeck M. Current treatment and prognosis in children with functionally univentricular hearts. Arch Dis Child, 2005, 90 (7):757-762.
24.	Tanoue Y, Kado H, Boku N, et al. Three hundred and thirty-three experiences with the bidirectional Glenn procedure in a single institute. Interact Cardiovasc Thorac Surg, 2007, 6 (1):97-101.

1. Yuan SM, Jing H. Palliative procedures for congenital heart defects. Arch Cardiovasc Dis, 2009, 102 (6/7):549-557.
2. 周诚, 董念国, 杜心灵, 等.姑息性手术在复杂先天性心脏病患者中的应用.中国胸心血管外科临床杂志, 2012, 19 (5):494-497.
3. Yamauchi H, Imura H, Maruyama Y, et al. Evolution of staged approach for Fontan operation. J Nippon Med Sch, 2002, 69 (2):154-159.
4. Alsoufi B, Manlhiot C, Awan A, et al. Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation. Eur J Cardiothorac Surg, 2012, 42 (1):42-49.
5. Wolff D, van Melle JP, Ebels T, et al. Trends in mortality (1975-2011) after one-and two-stage Fontan surgery, including bidirectional Glenn through Fontan completion. Eur J Cardiothorac Surg, 2014, 45 (4):602-609.
6. Petrucci O, Khoury PR, Manning PB, et al. Outcomes of the bidirec-tional Glenn procedure in patients less than 3 months of age. J Thorac Cardiovasc Surg, 2010, 139 (3):562-568.
7. Lapar DJ, Mery CM, Peeler BB, et al. Short and long-term outcomes for bidirectional glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg, 2012, 94 (1):164-170.
8. Fujii Y, Sano S, Kotani Y, et al. Midterm to long-term outcome of total cavopulmonary connection in high-risk adult candidates. Ann Thorac Surg, 2009, 87 (2):562-570.
9. Stocker CF, Shekerdemian LS, Horton SB, et al. The influence of bypass temperature on the systemic inflammatory response and organ injury after pediatric open surgery:a randomized trial. J Thorac Cardiovasc Surg, 2011, 142 (1):174-180.
10. Sitniakowsky LS, Later AF, van de Watering LM, et al. The effect of RBC transfusions on cytokine gene expression after cardiac surgery in patients developing post-operative multiple organ failure. Transfus Med, 2011, 21 (4):236-246.
11. Liu JF, Lu YA, Chen HW, et al. Bidirectional glenn procedure without cardiopulmonary bypass. Ann Thorac Surg, 2004, 77 (4):1349-1352.
12. Bhan A. Off-pump bi-directional Glenn shunt:How I do it? Ann Pediatr Cardiol, 2008, 1 (2):131-134.
13. Hussain A, Saleem K, Inam-Ullah I, et al. Bidirectional glenn shunt without cardiopulmonary bypass. J Coll Physicians Surg Pak, 2009, 19 (11):682-685.
14. 陈海生, 刘盛华, 何勇, 等.非体外循环双向Glenn分流术治疗紫绀型复杂先天性心脏病.中国胸心血管外科临床杂志, 2009, 16 (2):146-147.
15. Lapar DJ, Mery CM, Peeler BB, et al. Short and long-term outcomes for bidirectional glenn procedure performed with and without cardiopulmonary bypass. Ann Thorac Surg, 2012, 94 (1):164-171.
16. Agarwal HS, Churchwell KB, Doyle TP, et al. Inhaled nitric oxide use in bidirectional Glenn anastomosis for elevated Glenn pressures. Ann Thorac Surg, 2006, 81 (4):1429-1434.
17. 岑坚正, 庄建, 陈欣欣, 等.双向Glenn手术治疗儿童功能性单心室68例分析.中华外科杂志, 2007, 45 (12):812-814.
18. Hussain A, Arfi AM, Hussamuddin M, et al. Comparative outcome of bidirectional Glenn shunt in patients with pulmonary vascular resis-tance>3.5 woods units versus < 3.5 woods units. Am J Cardiol, 2008, 102 (7):907-912.
19. 刘迎龙, 于存涛, 魏波, 等.非体外循环下行上腔静脉-肺动脉双向分流术的治疗体会.中华小儿外科杂志, 2003, 24 (3):218-220.
20. 丁芳宝, 梅举, 邹良建, 等.非体外循环下有搏动性双向Glenn手术治疗复杂先天性心脏病.中国胸心血管外科临床杂志, 2005, 12 (1):46-47.
21. Calvaruso DF, Rubino A, Ocello S, et al. Bidirectional glenn and antegrade pulmonary blood flow:temporary or definitive palliation? Ann Thorac Surg, 2008, 85 (4):1389-1396.
22. 吴淑群, 黄萍.复杂性先天性心脏病手术后乳糜胸的治疗体会.心血管康复医学杂志, 2006, 15 (1):40-41.
23. Kaulitz R, Hofbeck M. Current treatment and prognosis in children with functionally univentricular hearts. Arch Dis Child, 2005, 90 (7):757-762.
24. Tanoue Y, Kado H, Boku N, et al. Three hundred and thirty-three experiences with the bidirectional Glenn procedure in a single institute. Interact Cardiovasc Thorac Surg, 2007, 6 (1):97-101.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Bidirectional Glenn Procedure for the Treatment of Complex Cyanotic Congenital Heart Diseases

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content