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Central pulmonary artery growth patterns after the bidirectional Glenn procedure
A M Mendelsohn1, E L Bove, F M Lupinetti
1Department of Pediatrics, University of Michigan Medical Center, Ann Arbor 48109-0204.
Summary
The bidirectional Glenn procedure in patients with univentricular hearts led to decreased pulmonary artery size, particularly contralateral to the shunt. This reduction, especially after 15 months, impacts future Fontan repair considerations.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease
- Surgical Outcomes
Background:
- Univentricular cardiac anatomy presents complex surgical challenges.
- The bidirectional Glenn procedure is a palliative step towards Fontan completion.
- Pulmonary artery development is crucial for Fontan circulation success.
Purpose of the Study:
- To evaluate changes in pulmonary artery size and hemodynamics after bidirectional Glenn procedures.
- To assess the impact of the procedure on pulmonary artery dimensions.
- To determine implications for subsequent Fontan repair.
Main Methods:
- Retrospective analysis of 30 patients with univentricular hearts.
- Serial angiographic and hemodynamic assessments before and after surgery.
- Comparison of pulmonary artery diameters and Nakata index pre- and post-procedure.
Main Results:
- Significant decrease in contralateral pulmonary artery diameter (p=0.04).
- 32% decrease in Nakata index (total pulmonary artery area) post-procedure (p=0.004).
- Decreased pulmonary blood flow, pulmonary artery pressure, and increased oxygen saturation, not correlating with size changes.
Conclusions:
- The bidirectional Glenn procedure leads to significant pulmonary artery remodeling, particularly in the contralateral vessel.
- Nakata index decrease is more pronounced after 15 months, suggesting time-dependent changes.
- Observed pulmonary artery changes may influence the feasibility and timing of total cavopulmonary anastomosis.