Late bidirectional glenn anastomosis in a 54-year-old patient with unoperated functionally univentricular heart

We report the case of a 54-year-old patient with complex univentricular physiology who presented with worsening exercise intolerance, chronic cyanosis, and uncontrolled heart failure. Investigations included echocardiography, cardiac magnetic resonance imaging, and cardiac catheterization. After discussion in a multidisciplinary meeting, the patient underwent successful surgery that included a bidirectional Glenn anastomosis and repair of the atrioventricular (AV) junction. She recovered well and on follow-up had substantially less cyanosis and heart failure. We demonstrated that common AV valve repair and Glenn shunt can be used together successfully in appropriately selected older patients as palliation for complex congenital heart disease with functionally univentricular physiology.