title: Results of additional pulsatile pulmonary blood flow with bidirectional glenn cavopulmonary anastomosis: positive effect on main pulmonary artery growth and less need for fontan conversion.
abstract: BACKGROUND
  Additional antegrade pulsatile pulmonary blood flow obtained by leaving the main pulmonary artery patent during bidirectional cavopulmonary shunt has been shown to give additional benefits to the bidirectional Glenn cavopulmonary anastomosis. We retrospectively evaluated our 20-patient pulsatile Glenn series in order to find out whether these salutary effects were valid or not.
  
  
  METHODS
  Between June 2007 and November 2011, 20 patients (11 girls and 9 boys) with single-ventricle physiology underwent bidirectional cavopulmonary anastomosis. The additional source of blood flow was through the unligated main pulmonary artery in all patients. A retrospective review of our surgical experience was performed focusing on the role of additional pulmonary flow. Medical records and perioperational and postoperative follow-up data including clinical outcomes were retrospectively retrieved and analyzed.
  
  
  RESULTS
  Two patients died in the early postoperative period. One patient died in the follow-up period. Mean follow-up time was 23.9 ± 15.7 months. No superior vena cava syndrome and no increase in pulmonary vascular resistance were observed. Improvement of partial oxygen pressure after pulsatile Glenn has been shown in all patients (P = .00). At a mean interval of 22.9 months, main pulmonary artery size continued to increase after pulsatile Glenn cavopulmonary anastomosis (P = .028). Only 1 patient was converted to Fontan type circulation after pulsatile Glenn cavopulmonary anastomosis.
  
  
  CONCLUSIONS
  The pulsatile cavopulmonary shunt is a useful procedure in the early and intermediate term management of patients with a functional univentricular heart. It improves partial oxygen pressure and the impact of pulsatility on the main pulmonary artery.
authors: Department of Cardiovascular Surgery, Başkent University Adana Medical Center, Adana, Turkey. osdemirtuk@yahoo.com
authors: Orhan Saim
authors: OS
authors: Demirtürk
authors: Murat
authors: M
authors: Güvener
authors: Isa
authors: I
authors: Coşkun
authors: Selman Vefa
authors: SV
authors: Yıldırım
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D018729:Fontan Procedure / Q000379:methods*; D018610:Heart Bypass, Right / Q000379:methods*; D006801:Humans; D008297:Male; D011651:Pulmonary Artery / Q000254:growth & development* / Q000503:physiopathology*; D011673:Pulsatile Flow; D013479:Superior Vena Cava Syndrome / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D016896:Treatment Outcome