Bidirectional Glenn anastomosis in staged treatment of patients with single ventricle: comparison between on-pump and off-pump technique

Introduction of the bidirectional Glenn procedure in patients with functional single ventricle [BDG] in Fontan candidates would improve clinical outcomes for all candidates underwent BDG and staged Fontan operation [total cavopulmonary connection TCPC]. We discuss indications for the bidirectional cavopuimonary connection. The Bi-directional Cavo-pulmonary [Glenn,] shunt is Commonly Performed Procedure for a variety of Cyanotic Congenital heart diseases that lead eventually to single ventricle repair. We report and Compare the results of Bi-directional Glenn operation done in University of Leipzig, heart Centre. Germany and Assiut University Paediatric Heart Surgery Centre, Egypt. Between November 2008 and July 2010 in Leipzig heart Centre and between March 2010 and March 2012 in Assiut University Paediatric Heart Surgery Centre, 26 patients [16 in Leipzig and 10 in Assiut] aged 3 months to 5 years received a bidirectional Glenn Shunt with the use of a temporary shunt [in Assiut = Group I] or cardiopulmonary bypass [CPB] [in Leipzig = Group II]. Arterial oxygen saturation rose from 78% +/- 8.5% preoperatively to 90% +/- 4.3% postoperatively. Hemodynamic studies showed a mean postoperative superior vena cava pressure of 13 +/- 2 mm H[2]O. No patient had desaturation and the shunt was taken down, 1 required reexploration for bleeding [Leipzig Group], and 1 needed prolonged drainage of 9 to 19 days [Assiut group], 1 of whom had chylothorax [Assiut group]. Hospital stay, was 9.3 +/- 3.5 days. There were one postoperative deaths [1.8%.] from cerebral haemorrhage [Assiut Group]. The bidirectional Glenn shunt remains an excellent palliative procedure as a preliminary step to a Fontan operation, or as an integral part of a Fontan or modified Fontan operation when the procedure is deferred because of age, weight, or cardiac malformations characterized by a hypoplastic right or left ventricle

Temporary tricuspid valve detachment for perimembranous VSD closure in children [early and long-term results]

VSDs can be successfully closed using a transatrial approach working across the tricuspid valve. Previous reports suggested tricuspid valve detachment technique [TVD] to improve exposure for closure of VSDs. However there has been concern that TVD might impair valve function, increase operative time and the incidence of postoperative heart block. Our Objective is to review the use of TVD technique for transatrial closure of perimembranous VSD in children and any resulting complications over 5 years postoperative follow up. This retrospective study reviewed the database from 2002 to 2007 and identified 158 children [91 males and 67 females] with mean age 3.16 +/- 2.6ys and weight 12.5 +/- 8.5 kg that underwent transatrial closure of pVSD in the Cardiotlioracic Surgery department, Assiut University Hospitals. Patients with types other than pVSDs and who underwent VSD closure via pulmonary artery or ventriculotomy were excluded from the study. Out of 158 children, 22 [13.9%] were operated with TVD technique while 136 [86.1%] were non TVD. The diagnosis of VSD and the postoperative follow up [Immediately and over 5ys] were done clinically and by echocardiography in the Pediatric Cardiology unit, Children University Hospital. VSD patch closure was done in 79% and primary closure in 21%. Mean cardiopulmonary bypass time was 58 +/- 14 min, cross clamp time was 41 +/- 13 min and postoperative hospital duration was 6.4 +/- 2.8 days with no significant difference between TVD and non TVD group No postoperative heart block or needs for pacemaker implantation were recorded in both groups on postoperative follow up there was a significant improvement in the cardiac size, chest infections and infective endocarditis and this become more pronounced over years and significantly better in TVD than non TVD group. Immediately postoperative and on follow up echocardiography determined grade I-IIITR significantly lower [16.5% and 12.2% respectively] than preoperative [39%] with no significant difference between TVD and non TVD group. Insignificant residual VSD shunting was detected in 8% of non TVD patients that spontaneously closed on follow up with only residual VSD in 2-4%. No residual VSD shunting was detected in TVD group. Improvement in almost all echocardiographic parameters with no significant difference in between groups was detected on follow up. The study concludes that pVSD can be closed with low complication rate using TVD technique TVD is a safe method to enhance the exposure of VSD with no residual VSD shunting, less postoperative TR and it does not result in tricuspid valve dysfunction on follow up. It could be freely used for difficult VSD exposure