title: Is additional pulsatile pulmonary blood flow beneficial to patients with bidirectional Glenn?
abstract: OBJECTIVE
  To compare the results of bidirectional Glenn when performed with or without pulsatile pulmonary blood flow in a cohort of patients with a single ventricle.
  
  
  METHODS
  Records of 212 patients undergoing staged single ventricle palliation during a 10-year period were retrospectively reviewed. Of those, 103 (33 in pulsatile group A and 70 in nonpulsatile group B) were selected.
  
  
  RESULTS
  Demographics and pre- and intraoperative variables were comparable for both groups. There was no difference in oxygen saturations immediately after the bidirectional Glenn in the 2 groups. The duration and output of chest tube drainage, incidence of chylothorax, and total length of stay was higher in group A. There was no difference in the number of diuretics or oxygen requirement upon discharge between groups. Pre-Glenn measurements showed a mean McGoon ratio in group A of 1.5 (1.46-1.57) and in group B of 1.59 (1.53-1.7) (P = .11); however, there was a significant difference in the ratio between groups at pre-Fontan measurements: group A, 1.76 (1.73-1.79) and group B, 1.6 (1.53-1.66) (P < .05). At pre-Fontan measurements there was a significant difference in mean pulmonary artery pressure between group A (14 mm [12.8-15.2]) and group B (10 mm [9.7-11]) (P < .05) and a trend toward higher incidence of venovenous collaterals in group A. There was no perioperative or interstage mortality in either group.
  
  
  CONCLUSIONS
  Pulsatile bidirectional Glenn is associated with better pulmonary artery growth, which might improve long-term outcomes after Fontan. However, it was associated with a higher postoperative complication rate.
authors: Division of Pediatric Cardiology, Hope Children's Hospital, Oak Lawn, IL, USA. sjulianaferns@yahoo.com
authors: Sunita J
authors: SJ
authors: Ferns
authors: Chawki
authors: C
authors: El Zein
authors: Kanwar
authors: K
authors: Multani
authors: Imran
authors: I
authors: Sajan
authors: Sujata
authors: S
authors: Subramanian
authors: Anastasios C
authors: AC
authors: Polimenakos
authors: Michel N
authors: MN
authors: Ilbawi
mesh_terms: D062186:Arterial Pressure; D015505:Chest Tubes; D016009:Chi-Square Distribution; D002675:Child, Preschool; D002916:Chylothorax / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D003097:Collateral Circulation; D004322:Drainage / Q000295:instrumentation; D005260:Female; D018729:Fontan Procedure / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006352:Heart Ventricles / Q000002:abnormalities / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D011651:Pulmonary Artery / Q000254:growth & development / Q000503:physiopathology / Q000601:surgery*; D011652:Pulmonary Circulation; D011673:Pulsatile Flow; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome