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Catheter closure of accessory pulmonary blood flow after bidirectional Glenn anastomosis using Amplatzer duct
Makram R Ebeid1, Charles H Gaymes, James A Joransen
1Division of Cardiology, Department of Pediatrics, University Of Mississippi Medical Center, Jackson, Mississippi, 39216, USA. mebeid@ped.umsmed.edu
Insights
An extra blood flow source to the lungs in patients with a bidirectional cavopulmonary anastomosis (Glenn shunt) can raise pulmonary artery pressure. Occluding this abnormal flow with an Amplatzer duct occluder successfully reduced Glenn pressure, aiding Fontan operation completion.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Congenital Heart Disease
Background:
- The bidirectional cavopulmonary anastomosis (Glenn shunt) is a surgical procedure to manage single-ventricle congenital heart defects.
- An additional source of pulmonary blood flow can elevate pulmonary artery pressure, complicating the subsequent Fontan operation.
Observation:
- A case involving a single-ventricle patient with a bidirectional cavopulmonary anastomosis presented with elevated Glenn pressure.
- This elevation was attributed to an unintended communication allowing additional blood flow from the ventricle to the pulmonary artery.
Findings:
- The abnormal ventricular-pulmonary artery communication was successfully occluded using an Amplatzer duct occluder.
- Following the occlusion, a satisfactory reduction in Glenn pressure was observed.
Implications:
- This intervention demonstrates a potential strategy to manage elevated pulmonary artery pressure in complex single-ventricle physiology.
- Successful management of Glenn pressure is crucial for enabling the completion of the Fontan operation.
- The use of an Amplatzer duct occluder offers a minimally invasive option for treating such specific hemodynamic challenges.
Abstract:
Additional source of pulmonary blood flow in patients with bidirectional cavopulmonary anastomosis (Glenn shunt) may cause elevation of the pulmonary artery pressure precluding safe completion of the Fontan operation. A case is presented with single-ventricle bidirectional cavopulmonary anastomosis and additional flow from the ventricle to the pulmonary artery resulting in elevated Glenn pressure. The communication was successfully occluded using Amplatzer duct occluder with satisfactory reduction in the Glenn pressure.
