The bidirectional cavopulmonary shunt for hypoplastic left. Bidirectional superior cavopulmonary connection bcpc is a widely used method of providing pulmonary blood flow in patients with complex congenital cardiac malformations characterised by univentricular atriovenous connections 1,2,3. Factors influencing arterial oxygenation early after bidirectional. The bidirectional cavopulmonary connection in the strategies employed to improve the outcome of the fontan operation, many now advocate staging with a bidirectional cavopulmonary connection, the socalled hemifontan procedure 1216. An exploratory study, american heart journal on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Single ventricle managementthird stagefontan goals of the operation complete separation of. The bidirectional cavopulmonary shunt improves systemic arterial oxygen. Initial bidirectional cavopulmonary shunt palliation should not be considered as a oneway path to. Objectiveto define the lowest age at which the bidirectional superior cavopulmonary anastomosis can safely be used in infants with complex congenital heart defects. Systemic haemodynamics and regional tissue oxygen saturation. The superior vena cava returns blood from the upper half of the body to the right atrium. The low arterial oxygen saturation sao 2 after bidirectional cavopulmonary shunt bcps predicts poor prognosis. Bidirectional glenn shunt, superior vena cava,tetrology of fallot,cardio pulmonary.
Karl the use of the bidirectional cavopulmonary shunt has had a favorable effect on the outcome of surgery for hypoplastic left heart syndrome. Between november 1993 and november 1996, 24 patients, aged between 0. Pdf the bidirectional cavopulmonary glenn shunt without. Bidirectional cavopulmonary shunt associated with ventriculo and valvuloplasty in ebsteins anomaly. Upon completion of the bidirectional cavopulmonary shunt operation, we addressed the stenotic lesions of the superior vena cava and left pulmonary artery, and a markedly expanded azygos vein.
The first bidirectional cavopulmonary shunt was performed in this population in 1988. It is also called bidirectional cavo pulmonary shunt bcps. Glenn anastomosis, by virtue of increasing the effective pulmonary flow improves the systemic arterial. The cavopulmonary connections used to stage the singleventricle patient to the modified fontan 1bdg 2hemifontan. The glenn procedure is formally known as the bidirectional cavopulmonary anastomosis. Designa retrospective analysis of clinical, echocardiographic, haemodynamic, and angiographic. The bidirectional glenn shunt for univentricular hearts springerlink. Pulmonary artery indices, including the lower lobe index, do not change significantly after bidirectional cavopulmonary shunt during mediumterm followup and do not influence the fontan outcome. Evaluation of bidirectional glenn shunt iosr journal. The physiology of the bidirectional cavopulmonary connection. Pulmonary blood supply in bidirectional cavopulmonary anastomosis with pulsatile pulmonary blood flow. At 6 years of age, the patient had worsening cyanosis with a saturation of 65%. Bidirectional glenn shunt, superior vena cava,tetrology of fallot, cardio pulmonary bypass. Indications and timing for the bidirectional glenn shunt.
All were alive and well 1448 months postoperatively, with satisfactory systemic saturations 8087% and haemodynamic indices. Single ventricle anatomy, physiology, and nomenclature. Combined construction of bidirectional cavopulmonary and aortopulmonary shunts as an intermediate stage in the repair of an 18yearold highrisk fontan candidate volume 6 issue 1 masaaki yamagishi, hiromi kurosawa, kazuhiro hashimoto. Bidirectional cavopulmonary shunt in patients with. Outcomes after bidirectional cavopulmonary shunt in. Bidirectional cavopulmonary shunt as a rescue procedure for. This surgery allows deoxygenated, blue blood from the head to drain passively to lungs. Mar 01, 2004 if this is the case, it would be interesting for the readers to know if the improved right ventricular function, with better antegrade pulsatile flow in the pulmonary artery, in any way interferes with the functioning of the bidirectional cavopulmonary shunt. Blalocktaussig shunt necessitates a single ventricle eject blood to both the systemic and pulmonary circulation. Bidirectional glenn shunt what is the fontan modification called the bidirectional glenn shunt. Bidirectional cavopulmonary shunt bcps is a surgical procedure used to treat complex cyanotic heart disease. In 1966, haberand coworkers 3 performed experimentally a cavopulmonary shunt with out proximal ligation of the right pulmonary artery, and in this way obtained a bidirectional cavopulmonary shunt bcs. Pdf bidirectional cavopulmonary shunt associated with.
Alternatively, the bidirectional glenn is another option to construct a superior cavopulmonary anastomosis figures 712. Bidirectional glenn procedure improves the mechanical efficiency of. Physiological rationale for a bidirectional cavopulmonary. This procedure may be an alternative to a right ventricular assist device in selected candidates. The superior cavopulmonary anastomosis is the first of two operations used in a staged fontan approach for definitive palliation of functionally single ventricle hearts. The bidirectional glenn shunt procedure involves rerouting circulation such that the superior vena cava svc drains into the right pulmonary artery. Extracardiac conduit total cavopulmonary anastomosis.
With a bidirectional cavopulmonary shunt and the use of an intraaortic balloon, the patient could be weaned successfully from cardiopulmonary bypass. The remaining 19 patients have been followed up for 2 months to 9 years with one late sudden death at 9 years. Combined construction of bidirectional cavopulmonary and. Read outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old, journal of the american college of cardiology on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The aviodance of cardiopulmonary bypass during the construction of anastomosis decreases the necessity of inotropic support, the duration of mechanical ventilation and the incidence of pleural effusions. Georgehyslop is an interprofessional education specialist in the cardiac critical care unit, labatt family heart centre, hospital for sick children, toronto, ontario, canada.
The bidirectional cavopulmonary glenn shunt is a commonly performed procedure for a variety of cyanotic congenital. Bidirectional cavopulmonary shunt hemifontan sts procedure code 1700. Our group has been investigating mechanical assistance for neonatal palliation for the functional single ventricle physiology. Energetic performance analysis of staged palliative surgery. Highrisk candidates who have undergone the bidirectional glenn procedure bdg. Systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a pdf plugin installed and enabled in your browser.
Outcomes after bidirectional cavopulmonary shunt in infants less than 6 months old. Pdf between june 1997 and july 2000, 170 patients aged 0. Somewhat simpler than the hemifontan from a technical standpoint, a bidirectional glenn does not address pulmonary artery hypoplasia or distortion by augmenting the pulmonary artery confluence, does not maintain the. In contemporary surgery, it is important to allow the child to grow sufficiently.
Dec 01, 2017 most infants who have singleventricle palliation undergo a sequence of surgeries to optimize pulmonary and systemic blood flow. Bidirectional cavopulmonary shunt bidirectional glenn sts procedure codes 1670,1690, 2, 2330. Logistic regression models were constructed to identify predictors of renal dysfunction. The bidirectional cavopulmonary shunt sciencedirect. The bidirectional cavopulmonary shunt bcps has become a well established procedure for the palliation of functional univentricular hearts 17. In contrast, 49 pts underwent bidirectional cavopulmonary shunting 47 or hemifontan procedure2 as an intermediate step to the fontan procedure with 4 8% early deaths. The superior cavopulmonary shunt unloads the single ventricle and, at the same time, provides a more reliable source of pulmonary arterial. Doppler flow profiles in the right and left pulmonary artery in children with congenital heart disease and a bidirectional cavopulmonary shunt. Circular shunt in bidirectional cavopulmonary anastomosis k.
Fontan completion rate and outcomes after bidirectional. Single ventricle managementthird stagefontan goals of the operation complete separation of the systemic venous blood blue. The bidirectional cavopulmonary shunt may be defined as an operation that diverts the systemic venous return from the superior vena cava or cavae to both lungs. Glenn shunts as a first or second palliative stage procedure. Conclusionsthis limited experience challenges the widely held belief that the bidirectional superior cavopulmonary anastomosis cannot be used as a primary palliation for complex heart disease in early infancy. After the superior cavopulmonary shunt, the patient. Analysis and prediction of collateral channels from left. Besides being used as an intermediate stage between systemictopulmonary artery shunt or pulmonary artery band and fontan procedure it. From a theoretical point of view, a bidirectional cavopulmonary shunt bcps associated with a wellcalibrated source of. Outcomes after bidirectional cavopulmonary shunt in infants. Bidirectional cavopulmonary shunt for acute right ventricular. Its advantages as a primary or secondstage palliative procedure include relief of the volume load on a single functional ventricle, improvement in atrioven. This results in deoxygenated blood returning from the head and upper body directly routed to the pulmonary arteries for oxygenation by the lungs, to some extent reducing the ventricular workload. The purpose of this study is to determine whether sivco 2 or q p q s should be increased to achieve better outcomes.
Request pdf on may 5, 2019, shuhua luo and others published low preoperative superior vena cava blood flow predicts bidirectional cavopulmonary shunt failure find, read and cite all the. Sep 07, 2019 bidirectional cavopulmonary shunt because of increasing cyanosis and growth cessation. During this operation, the superior vena cava was divided and we performed cavopulmonary. The procedure involves nonhhtrelated pavms are idiopathic, but other causes have been described and include infections, such as schistosomiasis 37 and actinomycosis 27. Mechanical cavopulmonary assist maintains pulmonary and. Although bcps is a well established procedure for the palliation of patients with a singleventricle heart, there have been very few reports of outcomes after bcps. Bidirectional cavopulmonary shunts the annals of thoracic surgery. They provide an easy method of monitoring circuit current and possess similarities to the sensitive analog voltmeter and external shunt resistor commonly used to measure current in the past. Accessory pulmonary blood flow was included in 18 patients. Sivasankaran, dm, dnb video clip is available online.
The first surgery to separate pulmonary and systemic blood flow is the bidirectional cavopulmonary shunt. The bidirectional cavopulmonary shunt, like the classic. This cavopulmonary connection provides excellent palliation in. Low preoperative superior vena cava blood flow predicts. Intermediate palliation using a bidirectional cavopulmonary shunt in recent years, the classic glenn shunt, which sacrifices the continuity between the right and left pulmonary arteries, has been replaced by the bidirectional cavopulmonary shunt, in which an endtoside anastomosis is constructed between the superior caval vein and the. From a theoretical point of view, a bidirectional cavopulmonary shunt bcps associated with a wellcalibrated source of additional pulmonary blood flow apbf should yield such a favourable haemodynamic status. For example, it may be done after the removal of the bt shunt or pulmonary artery banding. Quantification of collateral aortopulmonary flow in.
Energetic performance analysis of staged palliative. Cavopulmonary shunt definition of cavopulmonary shunt by. Pdf the ideal age for bidirectional glenn shunt bdgs as the first stage of staged. Of 60 extracardiac conduit fontan procedures performed between 1991 and 1996, only 6 patients had not undergone a previous bidirectional cavopulmonary shunt. The bidirectional glenn bdg procedure is frequently performed as part of the staged surgical management of single ventricle patients who will ultimately undergo a fontan operation. Pdf outcomes after bidirectional cavopulmonary shunt in. Students corner bidirectional cavopulmonary shunt for. Although not exactly a fontan operation, a bidirectional glenn bdg shunt is similar to it and is called a type of partial fontan operation. The bidirectional cavopulmonary shunt improves systemic arterial oxygen saturation without increasing ventricular work or pulmonary vascular resistance. Current outcomes of the bidirectional cavopulmonary.
We proposed, in the late 1980s, the hypothesis that bcps with apbf may provide a longlasting, and potentially, definitive palliation. Twentyfive patients in whom a modified fontan operation was deferred because of multiple risk factors underwent a bidirectional cavopulmonary shunt. The median age at bidirectional cavopulmonary shunt was 1. The role of bidirectional cavopulmonary shunt on selection of. During this operation, the superior vena cava was divided and we performed cavopulmonary shunting with the azygos vein. Right internal jugular vein cannulation was avoided because any stenosis of the superior vena cava would prove extremely detrimental in infants with single ventricle physiology as the preferred palliation would most likely be staged bidirectional cavopulmonary shunt glenn and total cavopulmonary anastomosis fontan procedures. The mechanical cavopulmonary assist group had higher doppler velocities of the middle cerebral artery and higher transcerebral oxygen difference p bidirectional cavopulmonary shunting 47 or hemifontan procedure2 as an intermediate step to the fontan procedure with 4 8% early deaths. Echocardiography showed a dilated coronary sinus with pulsatile flow into the right atrium figure 1, a and b, and video 1. To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Understanding stage ii bidirectional cavopulmonary shunts. Bidirectional cavopulmonary shunt is the interim procedure in palliation of patients with singleventricle physiology, but pulmonary arteriovenous malformations occur in many patients. The venous oxygen saturation of inferior vena cava sivco 2, as well as the pulmonary blood flowsystemic blood flow ratio q p q s affects the sao 2.
Seven years later, glenn 2 reported his experience using the standard cavopulmonary shunt to relieve cyanosis in patients with ccchd. Congenital cardiology today timely news and information for bcbe congenitalstructural cardiologists and surgeons key words. On the contrary, bidirectional cavopulmonary shunt release the single ventricle from pulmonary circulation. The number, shape, size, origin and entry, and course of collateral vessels from left superior vena cava were. Patients with previous bidirectional cavopulmonary shunt should be reevaluated before completion of fontan and, if cardiac anatomy allows, anatomical repair conversion may be considered, especially in patients with highrisk fontan completion. It was introduced into the palliative strategy to reduce the volume load on the hypertrophied single ventricle that pumps in parallel to the pulmonary and systemic circulations. Aortopulmonary and cavopulmonary shunts request pdf. Bidirectional cavopulmonary shunt was performed in 14 patients and the fontan procedure in 8 group c.
The mechanical assist configuration tested in this study a microaxial. There have been no bidirectional cavopulmonary shunt failures, stenoses, kinks, or recognized pulmonary arteriovenous malformations. Although the role of bidirectional cavopulmonary shunt bcps in such patients has been increasingly recognized, the impact of bcps on pvri has not been fully understood. Postoperatively, eight patients had assessment of pulmonary distribution of shunt blood flow by. Read risk factors for lifethreatening cavopulmonary thrombosis in patients undergoing bidirectional superior cavopulmonary shunt. The bidirectional cavopulmonary glenn shunt is a commonly performed procedure for a variety of cyanotic congenital heart diseases that lead eventually to a single ventricle repair. This procedure is done when only one ventricle works properly and not enough blood is getting to the lungs. The bidirectional cavopulmonary shunt for hypoplastic left heart syndrome tom r.
Most centers have adopted this strategy, including our own. Interactive cardiovascular and thoracic surgery systemic haemodynamics and regional tissue oxygen saturation after bidirectional cavopulmonary shunt. The effects of nonpulsatile blood flow on canine lungs. Read fontan completion rate and outcomes after bidirectional cavopulmonary shunt. Circular shunt in bidirectional cavopulmonary anastomosis. The bidirectional cavopulmonary shunt bcps or bidirectional glenn operation was introduced clinically by azzolina in 1972 and is a wellestablished palliative procedure for single ventricular heart 7,1015. We compared the perioperative hemodynamics of the staged operation between the two groups. Factors influencing arterial oxygenation early after bidirectional cavopulmonary shunt without additional sources of pulmonary blood flow. Bidirectional glenn shunt cavopulmonary shunt bdg the bidirectional glenn shunt dg is often the second procedure done in the pathway of single ventricle palliation. Pdf bidirectional glenn operation in infancy researchgate. Pulmonary blood supply in bidirectional cavopulmonary. Utility of bidirectional glenn shunts the annals of african surgery, january 2019 volume 16 issue 1 inferior vena cava ivc to the left pulmonary artery in a patient with a prior cgs. Bidirectional cavopulmonary glenn anastomosis in pulmonary atresia with intact ventricular septum and right ventricle dependent coronary circulation abstract this is a case report of an 8monthold infant with congenital heart disease including.
Dec 14, 2017 staged palliative surgery markedly shifts the balance of volume load on a single ventricle and pulmonary vascular bed. A dualpolarity, bidirectional current shunt monitor currentshuntmonitor ics are an extension of the instrumentation amplifier family of products. Since 1983, 17 patients have undergone a cavopulmonary shunt procedure five primary operations, 12 secondary operations. Increased systemic cardiac output improves arterial oxygen. Conclusions apc blood flow can be noninvasively measured in bidirectional cavopulmonary connections and fontan patients, using mri in the majority of patients and results in a significant lefttoright shunt. A right cavopulmonary shunt was done for an infant with tricuspid atresia, ventricular defect, and pulmonary stenosis, improving his oxygen saturation from 83% to 90%. Patients with a previous rightsided modified blalocktaussig shunt had more collateral flow to the right lung than those without. Doppler flow profiles in the right and left pulmonary artery in children with congenital heart disease and a bidirectional. In addition, at the time of the modified fontan operation, the cavopulmonary shunt. The role of bidirectional cavopulmonary anastomosis for palliation of complex cyanotic congenital heart disease is widely recognized. Inferior vena cavapulmonary artery extracardiac conduit. Bidirectional cavopulmonary anastomosis glenn procedure. Besides being used as an intermediate stage between systemictopulmonary artery shunt or pulmonary artery band and fontan procedure it has.
Bidirectional cavopulmonary shunt has become an increasingly applied procedure in patients with single ventricle physiology. Bidirectional cavopulmonary shunt using the azygos vein. All patients were consid ered less than ideal candidates for a fontan. Understanding stage ii bidirectional cavopulmonary shunts cecilia st. We report a case of tricuspid atresia patient who underwent first palliative surgery and second. Current outcomes of the bidirectional cavopulmonary anastomosis in single ventricle patients. Cavopulmonary support with a microaxial pump for the failing. Bidirectional cavopulmonary shunt with additional pulmonary blood. Pdf bidirectional cavopulmonary shunt without cardiopulmonary.
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