title: Venoatrial shunt-assisted cavopulmonary anastomosis.
abstract: The bidirectional Glenn shunt operation is conventionally performed under cardiopulmonary bypass. Between June 2007 and September 2009, 218 consecutive patients underwent off-pump bidirectional Glenn shunt institution for single ventricle with pulmonary stenosis complex. Their mean age was 4.72 ± 1.80 years (range, 4 months to 6 years) and median weight was 10.12 kg (range, 4.1-19 kg). A temporary shunt was created between the innominate vein and the right atrium, with a 3-way connector for de-airing. Fifty-five patients had bilateral cavae. The mean internal jugular venous pressure on clamping the superior vena cava was 24.69 ± 1.81 mm Hg. Continuous end-tidal CO₂ and O₂ saturation were monitored. Adequate oxygen saturation and blood pressure were maintained by optimizing inotropics, volume, and inspired oxygen. The mean duration of ventilation was 10.17 ± 8.96 h (range, 1-73 h). There were no gross neurological complications. Postoperative pleural effusion developed in 6 (2.75%) patients, and 4 (1.83%) had nodal rhythm. Four (1.83%) patients died in the immediate postoperative period due to low cardiac output syndrome. Venoatrial shunt-assisted bidirectional Glenn shunt surgery can be performed safely by optimizing intraoperative management strategies. It is economical and avoids the deleterious effects cardiopulmonary bypass.
authors.affiliation: Department of Pediatric Cardiac Surgery, Innova Children's Heart Hospital, Tarnaka, Secunderabad, India. drpramodreddy@yahoo.com
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: Ivatury Mrityunjaya
authors.initials: IM
authors.lastname: Rao
authors.forename: Kona Samba
authors.initials: KS
authors.lastname: Murthy
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology; D016121:Brachiocephalic Veins / Q000503:physiopathology*; D002303:Cardiac Output, Low / Q000209:etiology / Q000401:mortality; D002315:Cardiopulmonary Bypass; D002496:Central Venous Pressure; D002648:Child; D002675:Child, Preschool; D017548:Echocardiography, Transesophageal; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D006325:Heart Atria / Q000503:physiopathology; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D010996:Pleural Effusion / Q000209:etiology; D011666:Pulmonary Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome