Extending the Lower Limits of Body Weight for Bi-directional Glenn Shunt in Developing Countries: Is it Feasible?

The bi-directional Glenn (BDG) shunt is an established stage of palliation for functionally single-ventricle congenital heart disease, but optimal timing and the influence of severe underweight remain uncertain. We report a 102-day-old male infant, born at 38 weeks' gestation and weighing 2.7 kg at surgery, with double-outlet right ventricle, difficult/non-routable intracardiac anatomy, D-malposed great arteries, and severe pulmonary stenosis who underwent a right-sided BDG with atrial septectomy and partial main pulmonary artery (PA) ligation. The infant was discharged on postoperative day 11 with an oxygen saturation of 92%. Available follow-up documentation over 18 months described a patent BDG on two-dimensional echocardiography. This single case demonstrates technical feasibility in a selected severely underweight infant; it does not establish a safe lower age or weight threshold, comparative mortality, or long-term Fontan outcome. Larger studies with complete nutritional, hemodynamic, and longitudinal follow-up data are required.