Author + information
- Samuel Casella,
- James Lock,
- Aditya Kaza,
- Pedro del Nido and
- Audrey Marshall
Background: Additional pulmonary blood flow (PBF) into a Glenn shunt improves oxygenation at the risk of veno-venous collaterals, effusions, and Superior Vena Cava (SVC) hypertension. In select patients with unilateral pulmonary vascular abnormalities, targeted supplemental PBF may improve antegrade flow and permit eventual Fontan completion. We have attempted this by inserting a relatively small shunt into the affected pulmonary artery (PA) and banding the connection to the SVC-supplied lung, in an approach referred to as a “Super Glenn.”
Methods: We reviewed the charts and primary catheterization data for all patients who received a Super Glenn from 2000-2015. Comparisons of non-parametric variables were performed with the Wilcoxon sign rank test.
Results: We identified 20 patients with a median age and weight of 12.3mo and 7.9kg at intervention. Median follow up was 26mo. Vascular pathology included unilateral PA (n=8) or venous (n=5) obstruction, combined disease (n=4), or superabundant aortopulmonary collaterals (n=3). Nine patients had exclusively retrograde flow to the affected lung. There were 3 deaths: 45 days, 6mo and 8yrs postoperatively. Ten survivors had serious complications: pleural effusions (n=4), shunt thrombosis (n=3), SVC hypertension (n=2), reperfusion injury (n=1), hemidiaphragm paresis (n=1). 16 of 20 patients had initial qualitative improvement of their pulmonary vascular abnormality and all 9 patients with retrograde flow had restoration of antegrade PBF. There was no significant difference in systemic or SVC O2 saturation, or SVC pressure. There was a small increase in the shunted PA O2 saturation and pressure of 4% and 6mmHg, respectively. Presently, 8 patients have achieved a definitive palliation: 7 Fontans, 1 biventricular repair. Three patients had no improvement due to pulmonary vein atresia. A fourth patient was palliated as a Fontan with the shunt in place. Five patients are stable and awaiting further palliation.
Conclusions: The use of targeted additional PBF may be useful for the palliation of single ventricle patients with severely abnormal pulmonary vasculature. However, morbidity and mortality are common in this inherently high risk population.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Congenital Heart Disease Surgery: Updates and Innovations
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 1272-023
- 2017 American College of Cardiology Foundation