Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-13T01:43:39.432Z Has data issue: false hasContentIssue false
  • English
  • Français

Experience with the Glenn anastomosis in the adult with cyanotic congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Amalia Elizari  and
Jane Somerville
Amalia Elizari
Affiliation:
Jane Somerville Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
Jane Somerville*
Affiliation:
Jane Somerville Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
*
Dr Jane Somerville, 81/83 Harley Street, London W1N 1DE, UK. Tel: 0171 299 9407; Fax: 0171 299 9409
Get access Rights & Permissions [Opens in a new window]

Abstract

A clinical study on the outcomes of Glenn anastomoses performed since 1987 in eight consecutive patients aged ≥16 years, and in two performed earlier, showed poor results. One badly selected patient died early as a consequence of high venous pressure, while a further seven had early complications. Seven of eight hospital survivors were followed for 1–10 (median 4.2) years with two deaths (1 and 4 years later). Of the remaining five patients, two improved temporarily, but increased arterial oxygen saturation was not maintained after 6 months. The two patients who had undergone a Glenn anastomosis 10 and 34 years earlier were shown to have pulmonary arteriovenous fistulas. The Glenn anastomosis in these older patients is associated with high rates of complication and appears not to give adequate palliation, particularly when it is the only source of pulmonary blood supply. In the adult, the Glenn anastomosis can be used as a staging procedure for Fontan-type surgery, but must be combined with another source of pulmonary arterial supply. Any adult having a Glenn anastomosis, particularly without another source of pulmonary arterial supply, should be warned of the possibility of worsening of cyanosis and symptoms. The second stage of the procedure may need to be performed soon after the first should the hypoxia prove intolerable.

Keywords

Glenn anastomosisgrown-up congenital heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 3 , May 1999 , pp. 257 - 265
Copyright
Copyright © Cambridge University Press 1999

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Carlon, CA, Mondini, PG, de Marchi, R. Surgical treatment of some cardiovascular disease (a new vascular anastomosis). J Int Coll Surg 1951; 16: 1–10.Google Scholar
2.Glenn, WWL. Circulatory bypass of the right sided of the heart: shunt between superior vena cava and distal right pulmonary artery – report of clinical application. N Engl J Med 1958; 259: 117–121.CrossRefGoogle Scholar
3.Azzolina, G, Eufrate, S, Pensa, P. Tricuspid atresia: experience in surgical management with a modified cavopulmonary anastomosis. Thorax 1972; 27: 111–115.CrossRefGoogle ScholarPubMed
4.Abrams, L (personal communication to Dr WWL Glenn, quoted in Editorial). Superior vena cava-pulmonary artery anastomosis. Ann Thorac Surg 1984; 37: 9–11.Google Scholar
5.Martin, SP, Anabtawi, IN, Selmonosky, CA, Folger, GM, Ellison, LT, Ellison, RG. Long term follow-up after superior vena cavaright pulmonary artery anastomosis. Ann Thorac Surg 1970; 39: 339–346.CrossRefGoogle Scholar
6.Laks, H, Mudd, JG, Standeven, JWFagan, L, Willman, VL. Long-term effect of the superior vena cava–pulmonary artery anastomosis on pulmonary blood flow. J Thorac Cardiovasc Surg 1977; 74: 253–260.CrossRefGoogle ScholarPubMed
7.Warnes, CA, Somerville, J. Tricuspid atresia in adolescents and adults: current state and late complications. Br Heart J 1986; 56: 535–543.CrossRefGoogle ScholarPubMed
8.DeLeon, SY, Idriss, FS, Ilbawi, MN, Muster, AJ, Paul, MH, Cole, RB, Riggs, TW, Berry, TE. The role of the Glenn shunt in patients undergoing the Fontan operation. J Thorac Cardiovasc Surg 1983; 85: 669–677.CrossRefGoogle ScholarPubMed
9.Salim, MA, Thomas, G, DiSessa, TG, Arheart, KL, Alpert, BS. Contribution of superior vena caval flow to total cardiac output in children. A Doppler echocardiographic study. Circulation 1995; 92: 1860–1865.CrossRefGoogle ScholarPubMed
10.Mohiaddin, RH, Wann, SL, Underwood, R, Firmin, DN, Rees, S, Longmore, DB. Vena caval flow: assessment with the cine MR velocity mapping. Radiology 1990; 177: 537–541.CrossRefGoogle ScholarPubMed
11.Mainwaring, RD, Lamberti, JJ, Uzark, K, Spicer, RL. Bidirectional Glenn: is accessory pulmonary blood flow good or bad? Circulation 1995; 92 (suppl. II): II294–II297.CrossRefGoogle ScholarPubMed
12.Frommeit, MA, Frommeit, PC, Berger, S, Pelech, AN, Lewis, DA, Tweddel, JS, Litwin, SB. Does an additional source of pulmonary blood flow alter outcome after a bidirectional cavopulmonary shunt? Circulation 1995; 92 (suppl. II): II240–II244.CrossRefGoogle Scholar
13.Reddy, MV, McElhinney, DB, Moore, P, Bristow, J, Haas, GS, Hanley, FL. An institutional experience with the bidirectional cavopulmonary shunt: do we know enough about it? Cardiol Young 1997; 7: 284–293.CrossRefGoogle Scholar
14.Uemura, H, Yagihara, T, Kawashima, Y, Okada, K, Kamiya, T, Anderson, RH. Use of the bidirectional Glenn procedure in the presence of forward flow from the ventricles to the pulmonary arteries. Circulation 1995; 92 (suppl. II): II228–II232.CrossRefGoogle Scholar
15.Forbes, TJ, Gajarski, R, Johnson, GL, Reul, GJ, Ott, DA, Dreshker, K, Fischer, DJ. Influence of age on the effect of bidirectional cavopulmonary anastomosis on left ventricular volume, mass and ejection fraction. J Am Coll Cardiol 1996; 28: 1301–1307.CrossRefGoogle ScholarPubMed
16.Sluysmans, T, Sanders, SP, van der Velde, M, Matitiau, A, Parness, IA, Spevack, PJ, Mayer, JE, Colan, SD. Natural history and patterns of recovery of contractile function in single left ventricle after Fontan operation. Circulation 1992; 86: 1753–1761.CrossRefGoogle ScholarPubMed
17.Alejos, JC, Williams, RG, Jamakani, JM, Galindo, AJ, Isabel-Jones, JB, Drinkwater, D, Laks, H, Kaplan, S. Factors influencing survival in patients undergoing the bidirectional Glenn anastomosis. Am J Cardiol 1995; 75: 1048–1050.CrossRefGoogle ScholarPubMed
18.Berstein, HS, Brook, MM, Silverman, NH, Bristow, J. Development of pulmonary arteriovenous fistulae in children after cavopulmonary shunt. Circulation 1995; 92 (suppl. II): II309–II314.CrossRefGoogle Scholar