Application of bidirectional Glenn procedure in adult congenital heart disease_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Jue ,  CHEN Jimei , HE Biaochuan , CEN Jianzheng , WEN Shusheng , XU Gang , CUI Hujun , NIE Zhiqiang , ZHUANG Jian

Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, 510080, P.R.China;

Corresponding author：

CHEN Jimei, Email: jimei@hotmail.com

Keywords：

Adult congenital heart disease; bidirectional Glenn procedure; single ventricle; atrioventricular valve regurgitation

DOI：

10.7507/1007-4848.201609036

Video：

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Objective To analyze the feasibility of bidirectional Glenn procedure (BDG) in treatment of adult congenital heart disease (ACHD). Methods From December 2004 to December 2015, 42 ACHD patients received BDG in our hospital. There were 23 males and 19 females with a mean age of 24.6±8.5 years (range: 18 to 49 years). There were functional single ventricle (FSV) in 14 patients, Ebstein’s anomaly in 11, corrected transposition of great arteries in 7, transposition of great arteries in 5, double outlet of right ventricle in 3 and tricuspid atresia in 2. Twenty patients suffered moderate or severe atrioventricular valve regurgitation (AVVR). Half of the patients were operated upon with cardiopulmonary bypass (CPB) and the others with off-pump coronary artery bypass grafting (OPCABG). Thirty-four patients underwent unilateral BDG shunt and eight bilateral BDG shunts. Concomitant procedures included correction of Ebstein’s anomaly (7 patients), atrioventricular valve replacement (7), atrial septostomy (3), ligation of patent ductus arteriosus (3), ligation of major aortopulmonary collateral arteries (2), correction of total anomalous pulmonary venous connection (1) and mitral valve repair (1). Results The early operative mortality was 9.5% (4/42). FSV and moderate or severe AVVR were risk factors for BDG in ACHD. Early postoperative oxygen saturation increased from 78.8%±11.2% to 89.3%±6.6% (P<0.05). The follow-up time was 6-132 (41.4±33.1) months. There was no death. The heart function improved (2.7±0.5 vs. 1.9±0.4, P<0.05). Conclusion The BDG shunt can be applied to ACHD. Although the early mortality is relatively high, the middle- and long-term results are satisfactory. The oxygen saturation increases and the heart function improves. The life quality of patients will also improve. FSV and moderate or severe AVVR are risk factors for BDG in ACHD.

Citation： YANG Jue, CHEN Jimei, HE Biaochuan, CEN Jianzheng, WEN Shusheng, XU Gang, CUI Hujun, NIE Zhiqiang, ZHUANG Jian. Application of bidirectional Glenn procedure in adult congenital heart disease. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(9): 667-671. doi: 10.7507/1007-4848.201609036 Copy

1.	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.
2.	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.
3.	Mazzera E, Corno A, Picardo S, et al. Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation. Ann Thorac Surg, 1989, 47: 415.
4.	Martin SP, Anabtawi IN, Selmonosky CA, et al. Long term follow up after superior vena cava-right pulmonary artery anastomosis. Ann Thorac Surg, 1970, 9(4): 339-346.
5.	Laks H, Mudd JG, Standeven JW, et al. Long-term effect of the superior vena cava-pulmonary artery anastomosis on pulmonary blood flow. J Thorac Cardiovasc Surg, 1977, 74(2): 253-260.
6.	Tanoue Y, Sese A, Ueno Y, et al. Bidirectional Glenn procedure improves the mechanical efficiency of a total cavopulmonary connection in high risk Fontan candidates. Circulation, 2001, 103: 2176-2180.
7.	Ghanayem NS, Tweddell JS, Hoffman GM, et al. Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young, 2006, 16(suppl 1): 61-66.
8.	di Carlo D, Williams WG, Freedom RM, et al. The role of cavapulmonary (Glenn) anastomosis in the palliative treatment of congenital heart disease. J Thorac Cardiovasc Surg, 1982, 83(3): 437-442.
9.	Chang AC, Hanley FL, Wernovsky G, et al. Early bidirectional cavopulmonary shunt in young infants. Circulation, 1993, 88(5 Pt 2): Ⅱ149-58.
10.	Jonas RA. Comprehensive surgical management of congenital heart disease. London: Amold, 2004. 357-385.
11.	Vargas FJ, Mengo G, Gallo JP, et al. Bidirectional cavopulmonary shunt in patients with multiple risk factors. Ann Thorac Surg, 1995, 60(6 Suppl): S558-S562.
12.	Kopf GS, Laks H, Stansel HC, et al. Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg, 1990, 100(5): 662-670.
13.	Gross GJ, Jonas RA, Castaneda AR, et al. Maturational and hemodynamic factors predictive of increased cyanosis after bidirectional cavopulmonary anastomosis. Am J Cardiol, 1994, 74(7): 705-709.
14.	Marianeschi SM, McElhinney DB, Reddy VM, et al. Alternative approach to the repair of Ebstein’s malformantion: intracardiac repair with ventricular unloading. Ann Thorac Surg, 1998, 66(5): 1546-1550.
15.	Ovroutski S, Alexi-Meskishvili V, Ewert P, et al. Early and medium-term results after modified Fontan operation in adults. Eur J Cardiothorac Surg, 2003, 23(3): 311-316.
16.	Abdelrahman A, Vaikom SM, Conal A, et al. Late bidirectional Glenn anastomosis in a 54-year-old patient with unoperated functionally univentricular heart. World J Pediatr Congenit Heart Surg, 2013, 4(4): 444-446.
17.	Bradley SM, Mosca RS, Hennein HA, et al. Bidirectional superior cavopulmonary connection in young infants. Circulation, 1996, 94(9 Suppl): Ⅱ5-Ⅱ11.
18.	Duncan BW, Kneebone JM, Chie Y, et al. A detailed histologic analysis of pulmonary arteriovenous malformations in children with cyanotic congenital heart disease. J Thorac Cardiovasc Surg, 1999, 117(5): 931-938.
19.	Marshall B, Duncan BW, Jonas RA. The role of angiogenesis in the development of pulmonary arteriovenous malformations in children after cavopulmonary anastomosis. Cardiol Young, 1997, 7: 370-374.
20.	Bridges ND, Jonas RA, Mayer JE, et al. Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates: early results. Circulation, 1990, 82(Suppl): Ⅳ170-Ⅳ176.
21.	Hussain A, Arfi AM, Hussamuddin M, et al. Comparative outcome of bidirectional Glenn shunt in patients with pulmonary vascular resistance > or = 3.5 woods units versus < 3.5 woods units. Am J Cardiol, 2008, 102(7): 907-912.
22.	Reddy VM, McElhinney DB, Moore P, et al. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. J Am Coll Cardiol. 1997, 29(6): 1365-1370.

1. 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.
2. 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.
3. Mazzera E, Corno A, Picardo S, et al. Bidirectional cavopulmonary shunts: clinical applications as staged or definitive palliation. Ann Thorac Surg, 1989, 47: 415.
4. Martin SP, Anabtawi IN, Selmonosky CA, et al. Long term follow up after superior vena cava-right pulmonary artery anastomosis. Ann Thorac Surg, 1970, 9(4): 339-346.
5. Laks H, Mudd JG, Standeven JW, et al. Long-term effect of the superior vena cava-pulmonary artery anastomosis on pulmonary blood flow. J Thorac Cardiovasc Surg, 1977, 74(2): 253-260.
6. Tanoue Y, Sese A, Ueno Y, et al. Bidirectional Glenn procedure improves the mechanical efficiency of a total cavopulmonary connection in high risk Fontan candidates. Circulation, 2001, 103: 2176-2180.
7. Ghanayem NS, Tweddell JS, Hoffman GM, et al. Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis. Cardiol Young, 2006, 16(suppl 1): 61-66.
8. di Carlo D, Williams WG, Freedom RM, et al. The role of cavapulmonary (Glenn) anastomosis in the palliative treatment of congenital heart disease. J Thorac Cardiovasc Surg, 1982, 83(3): 437-442.
9. Chang AC, Hanley FL, Wernovsky G, et al. Early bidirectional cavopulmonary shunt in young infants. Circulation, 1993, 88(5 Pt 2): Ⅱ149-58.
10. Jonas RA. Comprehensive surgical management of congenital heart disease. London: Amold, 2004. 357-385.
11. Vargas FJ, Mengo G, Gallo JP, et al. Bidirectional cavopulmonary shunt in patients with multiple risk factors. Ann Thorac Surg, 1995, 60(6 Suppl): S558-S562.
12. Kopf GS, Laks H, Stansel HC, et al. Thirty-year follow-up of superior vena cava-pulmonary artery (Glenn) shunts. J Thorac Cardiovasc Surg, 1990, 100(5): 662-670.
13. Gross GJ, Jonas RA, Castaneda AR, et al. Maturational and hemodynamic factors predictive of increased cyanosis after bidirectional cavopulmonary anastomosis. Am J Cardiol, 1994, 74(7): 705-709.
14. Marianeschi SM, McElhinney DB, Reddy VM, et al. Alternative approach to the repair of Ebstein’s malformantion: intracardiac repair with ventricular unloading. Ann Thorac Surg, 1998, 66(5): 1546-1550.
15. Ovroutski S, Alexi-Meskishvili V, Ewert P, et al. Early and medium-term results after modified Fontan operation in adults. Eur J Cardiothorac Surg, 2003, 23(3): 311-316.
16. Abdelrahman A, Vaikom SM, Conal A, et al. Late bidirectional Glenn anastomosis in a 54-year-old patient with unoperated functionally univentricular heart. World J Pediatr Congenit Heart Surg, 2013, 4(4): 444-446.
17. Bradley SM, Mosca RS, Hennein HA, et al. Bidirectional superior cavopulmonary connection in young infants. Circulation, 1996, 94(9 Suppl): Ⅱ5-Ⅱ11.
18. Duncan BW, Kneebone JM, Chie Y, et al. A detailed histologic analysis of pulmonary arteriovenous malformations in children with cyanotic congenital heart disease. J Thorac Cardiovasc Surg, 1999, 117(5): 931-938.
19. Marshall B, Duncan BW, Jonas RA. The role of angiogenesis in the development of pulmonary arteriovenous malformations in children after cavopulmonary anastomosis. Cardiol Young, 1997, 7: 370-374.
20. Bridges ND, Jonas RA, Mayer JE, et al. Bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates: early results. Circulation, 1990, 82(Suppl): Ⅳ170-Ⅳ176.
21. Hussain A, Arfi AM, Hussamuddin M, et al. Comparative outcome of bidirectional Glenn shunt in patients with pulmonary vascular resistance > or = 3.5 woods units versus < 3.5 woods units. Am J Cardiol, 2008, 102(7): 907-912.
22. Reddy VM, McElhinney DB, Moore P, et al. Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. J Am Coll Cardiol. 1997, 29(6): 1365-1370.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Application of bidirectional Glenn procedure in adult congenital heart disease

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