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Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot

Published online by Cambridge University Press:  23 May 2019

Kamal Saleem ,
Iftikhar Ahmed ,
Mehboob Sultan ,
Intisar ul Haq ,
Umair Younus  and
William M Novick
Kamal Saleem
Affiliation:
Department of Pediatric Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, The Mall, Rawalpindi, Pakistan
Iftikhar Ahmed
Affiliation:
Department of Pediatric Cardiac Anesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, The Mall, Rawalpindi, Pakistan
Mehboob Sultan
Affiliation:
Department of Pediatric Cardiology, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, The Mall, Rawalpindi, Pakistan
Intisar ul Haq
Affiliation:
Department of Pediatric Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, The Mall, Rawalpindi, Pakistan
Umair Younus
Affiliation:
Department of Pediatric Cardiac Anesthesia, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, The Mall, Rawalpindi, Pakistan
William M Novick*
Affiliation:
University of Tennessee Health Science Center-Global Surgery Institute, Memphis, TN, USA William Novick Global Cardiac Alliance, Memphis, TN, USA
*
Author for correspondence: William M Novick, 1750 Madison Ave., Suite 500, Memphis, TN 38104, USA. Tel: +1-901-438-9413; E-mail: bill.novick@cardiac-alliance.org
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Abstract

Background:

Residual right ventricular outflow obstruction during Tetralogy of Fallot repair necessitates peri-operative revision often requiring trans-annular patch with its negative sequels. Bidirectional Glenn shunt in this setting reduces trans-pulmonary gradient to avoid revision.

Methods:

Bidirectional Glenn shunt was added during Tetralogy repair in patients with significant residual obstruction. A total of 53 patients between January, 2011 and June, 2018 were included. Final follow-up was conducted in July, 2018.

Results:

Mean age at operation was 5.63±3.1 years. Right to left ventricular pressure ratio reduced significantly (0.91±0.09 versus 0.68±0.05; p<0.001) after bidirectional Glenn, avoiding revision in all cases. Glenn pressures at ICU admission decreased significantly by the time of ICU discharge (16.7±3.02 versus 13.5±2.19; p<0.001). Pleural drainage ≥ 7 days was seen in 14 (26.4%) patients. No side effects related to bidirectional Glenn-like facial swelling or veno-venous collaterals were noted. Mortality was 3.7%. Discharge echocardiography showed a mean trans-pulmonary gradient of 32.11±5.62 mmHg that decreased significantly to 25.64±5 (p<0.001) at the time of follow-up. Pulmonary insufficiency was none to mild in 45 (88.2%) and moderate in 6 (11.8%). Mean follow-up was 36.12±25.15 months (range 0.5–90). There was no interim intervention or death. At follow-up, all the patients were in NYHA functional class 1 with no increase in severity of pulmonary insufficiency.

Conclusion:

Supplementary bidirectional Glenn shunt significantly reduced residual right ventricular outflow obstruction during Tetralogy of Fallot repair avoiding revision with satisfactory early and mid-term results.

Keywords

Bi-directional GlennTetralogy of Fallottrans-annular patchpulmonary valveinsufficiency
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 5 , May 2019 , pp. 684 - 688
Copyright
© Cambridge University Press 2019 

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