Experience with the Glenn anastomosis in the adult with cyanotic congenital heart disease.
A clinical study on the outcomes of Glenn anastomoses performed since 1987 in eight consecutive patients aged > or = 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.
Elizari
A
A
Jane Somerville Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK.
Somerville
J
J
D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical; D001166:Arteriovenous Shunt, Surgical; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000601:surgery*