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Convulsive syncope after bidirectional Glenn shunts: physiological implications for a neurological event.

Rajnish Duara¹, Sumanta Shekhar Padhi, Anand Padmanabhan Iyer

¹Department of Cardiovascular and Thoracic Surgery, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala-695011, India. rajnishduara@gmail.com

Interactive Cardiovascular and Thoracic Surgery

|August 3, 2007

Summary

Neurological complications like syncope can occur after bidirectional Glenn shunt surgery. A modified Valsalva maneuver may help identify patients at risk for these events.

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Area of Science:

Cardiology
Neurology
Pediatric Surgery

Background:

Neurological complications are occasionally observed after cavopulmonary connections, such as bidirectional Glenn shunt and Fontan procedures.
Convulsive syncope is a rare postoperative complication in patients undergoing single ventricle palliation.

Purpose of the Study:

To discuss a case of convulsive syncope following a bilateral bidirectional Glenn shunt.
To explore the physiological factors contributing to neurological events after cavopulmonary connections.
To introduce a novel preoperative test for identifying at-risk patients.

Main Methods:

A 5-year-old girl with tricuspid atresia and pulmonary stenosis underwent a bilateral bidirectional Glenn shunt.
Postoperatively, the patient developed convulsive syncope upon straining.
Neurological and arrhythmia studies were conducted, yielding no organic lesions.
A modified Valsalva maneuver was devised to assess physiological risk.

Main Results:

The patient experienced convulsive syncope post-bilateral bidirectional Glenn shunt, particularly on straining.
Extensive investigations did not reveal an underlying organic cause for the neurological event.
The study highlights the potential for physiological imbalances to trigger neurological symptoms after altered cardiac physiology.

Conclusions:

Diagnosing neurological events after single ventricle palliation is crucial for management.
Differentiating syncope from seizures has significant clinical implications.
Altered physiodynamics, particularly the balance between systemic venous pressure, pulmonary artery pressure, and intrathoracic pressure, can lead to neurological events.
A modified Valsalva maneuver shows promise as a clinical biomarker to identify patients susceptible to these complications.