title: Bidirectional Glenn shunt without cardiopulmonary bypass.
abstract: OBJECTIVE
  To determine the efficacy of bidirectional Glenn shunt (BDG) without cardiopulmonary bypass (CPB).
  
  
  METHODS
  Quasi experimental study.
  
  
  METHODS
  The Armed Forces Institute of Cardiology and National Institute of Heart Diseases (AFICNIHD), Rawalpindi.
  
  
  METHODS
  Thirty one patients underwent BDG without CPB between January 2006 to December 2007. Subjects for off pump BDG were those who did not require any intracardiac repair, had good sized branch pulmonary arteries, had acceptable PA pressures (< 16 mm Hg), and did not have any significant atrio-ventricular (AV) valve regurgitation. The off pump BDG was performed using veno-venous shunt between the superior vena cava (SVC) and right atrium (RA) following heparinization. All patients underwent discharge echocardiography to assess BDG patency. Statistical significance was determined using t-test with statistical significance at p < 0.05.
  
  
  RESULTS
  There were 18 males and 13 females. All patients survived. Twenty seven (87.09%) patients received BDG and 04 patients (12.90%) received bilateral BDG. Atrial septectomy with inflow occlusion was performed in 5 patients. Antegrade pulmonary blood flow was left in 24 (77.41%) of 31 patients. There was significant improvement in postoperative SpO2 (p = 0.000) in all the cases. There were no postoperative neurologic complications. Sepsis occurred in 2 patients who ultimately recovered. One patient had chylothorax which stopped after three (03) days in ICU. No SVC/PA distortions were noted by discharge echocardiography. Eliminating CPB reduced the cost of the procedure substantially and saved the patients from its inherent complications.
  
  
  CONCLUSIONS
  BDG without CPB is a safe procedure in selected patients. It avoids CPB related problems and is cost effective, with excellent results.
authors.affiliation: Department of Cardiac Surgery, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, 170-A Street No. 3, Afshan Colony, Rawalpindi. aabid884@yahoo.com
authors.forename: Abid
authors.initials: A
authors.lastname: Hussain
authors.forename: Kamal
authors.initials: K
authors.lastname: Saleem
authors.lastname: Inam-Ullah
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmed
authors.forename: Umair
authors.initials: U
authors.lastname: Younus
authors.forename: Azhar
authors.initials: A
authors.lastname: Rashid
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018610:Heart Bypass, Right / Q000379:methods*; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male