| Abstrakt: |
Background: the bidirectional Glenn shunt is still an essential step in physiologically single ventricle heart repair; as it offers excellent palliation, BDG shunt increases pulmonary blood flow, allows pulmonary arteries growth and improves arterial oxygen saturation. It also enables ventricular volume unloading, associated with a reduction in ventricular end-diastolic volume and ventricular hypertrophy, thus improves survival and quality of life. Aim of the Work: to register all patients post cavopulmonary anastomosis who developed collateral channels (including venovenous, aortopulmonary collaterals or collaterals to pulmonary veins) and the different methods of management followed and the impact of this management on patients with single ventricle physiology. Patients and Methods: our registry included 56 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from March 2022 till February 2023. Results: Our patients underwent bidirectional Glenn shunt at a median age of 2.08 (1-3) years which is considered a relatively old age compared to registries conducted in developed countries but similar to others studies that have been made in developing countries like Pakistan, India and Iran. In our study, we evaluated veno-venous and aorto-pulmonary collaterals in patients with bidirectional Glenn shunt. We studied prevalence and predictors of their development. We also studied different lines of management, the effect and complications of this management. Among the 56 patients included in our registry 41 patients (73.2%) had veno-venous collaterals and 37 patients (66.1%) had aorto-pulmonary collaterals. In our registry, we showed that transcatheter occlusion of collaterals is an effective and safe line of management of veno-venous and aortopulmonary collaterals, 7 patients underwent transcatheter closure of collterals, one of them underwent successful closure of aorto-pulmonary collaterals while the other 6 patients underwent veno-venous collaterals closure. In our registry, there was a statistically highly significant increase in SO2 (%) after transcatheter closure of veno-venous collaterals (82.83 6 9.87 Vs 69.83 6 10.91) with p-value = 0.008. Conclusion: the need for larger registries of post bidirectional Glenn shunt and post Fontan patients in our country is mandatory to cover different aspects of follow up and management of these patients that will give us more knowledge and experience that will result in improvement in the public health services for those selected population and will help us provide them a better quality of life and improve associated cardiac morbidity and mortality. [ABSTRACT FROM AUTHOR] |
