Objective To explore the effect of the bidirectional Glenn procedure on complex cardiac malformations with anomalies of systemic venous drainage (ASVD), pulmonary venous drainage (APVD), or both.
Methods Between March 2010 and December 2013, 29 patients with anomalous systemic or pulmonary venous drainage underwent bidirectional cavopulmonary shunt. The man age of these patients was (60.8 ± 49.6) months and the mean weight was weight (17.6 ± 10.4) kg. A combination of anomalous systemic and pulmonary venous drainage was present in 3 patients, whereas 20 patients had anomalous drainage only from the systemic circulation and 6 patients had isolated anomalies of pulmonary venous return.
Results All the patients underwent unilateral or bilateral bidirectional Glenn operation, and the associated procedures included ligation of small left superior vena cava in 3 patients, modified BT shunt to left pulmonary artery in 1 patient, correction of anomalous pulmonary venous drainage in 3 patients, atrioventricular valvuloplasty in 4 patients, pulmonary banding in 3 patients. There were 1 (3.4%) early death due to malignant arrhythmias. Two patients required for reoperation for bleeding, 2 patients developed pericardial effusion, 1 patient developed cerebral embolism and 1 patient developed wound dehiscence. At a mean follow-up of (17.4 ± 10.9) months, no death occurred, the mean blood oxygen saturation was (84 ± 6)%, and 2 patients have undergone total cavopulmonary connexion. One patient received radiofrequency ablation for WPW syndrome, and two patients need medication for decreasing pulmonary artery pressure.
Conclusion Bidirectional cavopulmonary shunt can be performed in patients with anomalous systemic or/and pulmonary venous drainage with satisfactory early and mid-term outcomes. The combination of multiple surgical procedures may be an important way to improve outcomes.
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