title: Veno-venous shunt-assisted cavopulmonary anastomosis.
abstract: OBJECTIVE
  The bidirectional Glenn shunt is commonly performed under cardiopulmonary bypass for conditions that lead to a single ventricle repair. We report our experience of bidirectional Glenn shunt done without cardiopulmonary bypass.
  
  
  METHODS
  Between June 2007 and May 2009, 186 consecutive patients underwent off-pump bidirectional Glenn shunt for a variety of complex cyanotic congenital heart defects. Age ranged from four months to six years and the median weight was 11.17 kg (range 4.3 - 18). After systemic heparinization, the procedure was done by creating a temporary shunt between the innominate vein and the right atrium connected across a three way connector for de-airing. Fifty one patients had bilateral cavae. All cases underwent complete clinical neurological examination.
  
  
  RESULTS
  No case required conversion onto cardiopulmonary bypass. Four patients (2.14%) died in the immediate postoperative period. The mean internal jugular venous pressure on clamping the decompressed superior vena cava was 24.69 +/- 1.81 mm Hg. There was no intra-operative hemodynamic instability and oxygen saturation was maintained at more than 70% throughout. Post Glenn shunt, the saturations improved to mid 80s. Seventy four cases had documented forward flow across the pulmonary valve. The mean duration of ventilation was 10.17 +/- 8.96 hours and there were no neurological complications. Six patients (3.22%) developed pleural effusions, 4 patients (2.15%) had nodal rhythm and 9 patients (4.83%) had superficial sternal wound infection.
  
  
  CONCLUSIONS
  Our results show that off-pump bidirectional Glenn shunt can be done safely in patients not requiring associated intra-cardiac correction. It avoids cardiopulmonary bypass and its related complications, is economical and associated with excellent results. In our opinion, this is the largest series of off-pump bidirectional Glenn shunt in the literature.
authors.affiliation: Department of Pediatric Cardiac Surgery and Cardiac Anesthesiology, Innova Children's Heart Hospital, Secunderabad, India.
authors.forename: Pramod Reddy
authors.initials: PR
authors.lastname: Kandakure
authors.forename: Anil Kumar
authors.initials: AK
authors.lastname: Dharmapuram
authors.forename: Suresh Babu
authors.initials: SB
authors.lastname: Kale
authors.forename: Vivek
authors.initials: V
authors.lastname: Babu
authors.forename: Nagarajan
authors.initials: N
authors.lastname: Ramadoss
authors.forename: Ramkinkar
authors.initials: R
authors.lastname: Shastri
authors.forename: Avinash
authors.initials: A
authors.lastname: Londhe
authors.forename: Ivatury Mrityunjaya
authors.initials: IM
authors.lastname: Rao
authors.forename: Kona Samba
authors.initials: KS
authors.lastname: Murthy
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