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Chapter 27 - Bidirectional Glenn

from Section 5 - Single-Ventricle Physiology

Published online by Cambridge University Press:  09 September 2021

By
Amanpreet S. Kalsi
Edited by
Laura K. Berenstain  and
James P. Spaeth
Laura K. Berenstain
Affiliation:
Cincinnati Children's Hospital Medical Center
James P. Spaeth
Affiliation:
Cincinnati Children's Hospital Medical Center
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Summary

This chapter details the perioperative management of an infant with hypoplastic left heart syndrome post stage II palliation who presents for hypospadias repair. The anatomy, physiology, and significance of manipulating pulmonary vascular resistance and systemic vascular resistance on systemic oxygen delivery are highlighted. In addition, intraoperative airway management, anesthetic and analgesic plans, as well as pharmacological agents are detailed. Considerations for suitability for outpatient surgery are mentioned. Finally, a summary of intraoperative goals pertinent to this congenital heart defect are listed.

Keywords

bidirectional Glenn shunthemi-Fontanhypoplastic left heart syndromehypospadias repairpulmonary vascular resistancesingle-ventricle physiologystage II palliationsuperior cavopulmonary anastomosis
Type
Chapter
Information
Congenital Cardiac Anesthesia
A Case-based Approach
 , pp. 198 - 206
Publisher: Cambridge University Press
Print publication year: 2021

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References

References

Freedom, R. M., Nykanen, D., and Benson, L. N.. The physiology of the bidirectional cavopulmonary connection. Ann Thorac Surg 1998; 66: 664–7.CrossRefGoogle ScholarPubMed
Von Ungern-Sternberg, B. S., Boda, K., Chambers, N. A., et al. Risk assessment for respiratory complications in paediatric anaesthesia: a prospective cohort study. Lancet 2010; 376: 773–83.Google Scholar
White, M. C. and Peyton, J. M.. Anaesthetic management of children with congenital heart disease for non-cardiac surgery. Cont Educ Anesth Crit Care Pain 2012; 12: 17–22.CrossRefGoogle Scholar
Nishimura, R. A., Otto, C. M., Bonow, R. O., et al. AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017; 135: e1159–95.Google Scholar
Al-Eyadhy, A.. Mechanical ventilation strategy following Glenn and Fontan surgeries: on going challenge! J Saudi Heart Assoc 2009; 21: 153–7.CrossRefGoogle ScholarPubMed
Bradley, S. M., Simsic, J. M., and Mulvihill, D. M.. Hypoventilation improves oxygenation after bidirectional superior cavopulmonary connection. J Thorac Cardiovasc Surg 2003; 126: 1033–9.Google Scholar

Suggested Reading

Feinstein, J. A., Benson, D. W., Dubin, A. M., et al. Hypoplastic left heart syndrome: current considerations and expectations. J Am Coll Cardiol 2012; 59: S1–42.CrossRefGoogle ScholarPubMed
Freedom, R. M., Nykanen, D., and Benson, L. N. The physiology of the bidirectional cavopulmonary connection. Ann Thorac Surg 1998; 66: 664–7.Google Scholar
Gupta, B., Gupta, A., Agarwal, M., et al. Glenn shunt: anaesthetic concerns for a non-cardiac surgery. North J ISA 2017; 2: 36–42.Google Scholar
White, M. C. and Peyton, J. M. Anaesthetic management of children with congenital heart disease for non-cardiac surgery. Cont Educ Anesth Crit Care Pain 2012; 12: 17–22.CrossRefGoogle Scholar

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