Targeted Increase in Pulmonary Blood Flow in a Bidirectional Glenn Circulation.

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Single Ventricle Physiology

Background:

• Patients with a Glenn shunt and unilateral pulmonary vascular abnormalities face challenges in achieving adequate pulmonary blood flow.
• Unilateral pulmonary vascular disease can impede Fontan completion and lead to complications.

Purpose of the Study:

• To evaluate the efficacy and safety of creating a targeted aortopulmonary shunt and central pulmonary artery banding in patients with Glenn shunt and unilateral pulmonary vascular abnormalities.
• To assess the impact of this intervention on antegrade pulmonary blood flow and potential for Fontan completion.

Main Methods:

• Retrospective review of 20 patients undergoing the procedure between 2000 and 2015.
• Analysis of vascular abnormalities including arterial/venous obstruction, hypoplasia, and aortopulmonary collaterals.
• Statistical comparison using the Wilcoxon signed rank test for nonparametric variables.

Main Results:

• All patients achieved postoperative antegrade flow to the target lung.
• Increased oxygen saturation and pressure in the shunted pulmonary artery were observed.
• Frequent complications included pleural effusions and shunt thrombosis; three patients died, while nine achieved definitive palliation.

Conclusions:

• Targeted additional pulmonary blood flow may be a viable palliative strategy for single ventricle patients with abnormal pulmonary vasculature.
• This intervention is associated with significant morbidity and mortality, requiring careful consideration in high-risk populations.