Is Interrupted Inferior Vena Cava a Risk Factor in Cases of Bilateral Bidirectional Glenn?
DOI:
https://doi.org/10.1532/HSF98.20081148Abstract
Introduction: Bilateral superior vena cava-to-pulmonary artery anastomoses are technically challenging. Bilateral superior vena cavae (SVCs) have been thought to be a risk factor for poor outcome in children needing single-ventricle palliation.
Methods: The files of forty children who underwent bilateral cavopulmonary anastomoses (CPAs) were reviewed.
Results: Forty patients (31 male, 9 female) had bilateral bidirectional Glenn shunts in King Faisal Specialist Hospital and Research Center, Jeddah, in 7 years. Interrupted inferior vena cava (IIVC) was present in 8 patients. All IIVC cases featured a hypoplastic right ventricle. Twenty-four patients had a hypoplastic right ventricular morphology, and 16 patients had a hypoplastic left ventricular morphology.
Conclusions: In single-ventricle anatomy, cases of a bilateral SVC are more often associated with an IIVC than a single SVC. Patients who undergo bilateral CPAs with an IIVC have a difficult early postoperative course. We should look for IIVC and either exclude or prove IIVC in cases of bilateral SVCs. Postoperative anticoagulation therapy in children with bilateral CPAs is important but should be investigated further.
References
Choussat A, Fontan F, Besse P, Vallot F, Chauve A, Bricaud H. 1978. Selection criteria for Fontan's procedure. In: Anderson RH, Shinebourne EA, eds. Paediatric cardiology. Edinburgh, UK: Churchill Livingstone. p 559-66.nChowdhury UK, Airan B, Sharma R, et al. 2001. One and a half ventricle repair with pulsatile bidirectional Glenn: results and guidelines for patient selection. Ann Thorac Surg 71:1995-2002.nHosein RBM, Clarke AJB, McGuirk SP, et al. 2007. Factors influencing early and late outcome following the Fontan procedure in the current era. The ‘Two Commandments’? Eur J Cardiothorac Surg 31:344-53.nIyer GKT, Van Arsdell GS, Dicke FP, McCrindle BW, Coles JG, Williams WG. 2000. Are bilateral superior vena cavae a risk factor for single ventricle palliation? Ann Thorac Surg 70:711-6.nKim SJ, Kim WH, Lim HG, Lee CH, Lee JY. 2006. Improving results of the Fontan procedure in patients with heterotaxy syndrome. Ann Thorac Surg 82:1245-51.nMavroudis C, Backer CL, Kohr LM, et al. 1999. Bidirectional Glenn shunt in association with congenital heart repairs: the 1 1/2 ventricular repair. Ann Thorac Surg 68:976-81.nMcElhinney DB, Reddy VM, Moore P, Hanley FL. 1997. Bidirectional cavopulmonary shunt in patients with anomalies of systemic and pulmonary venous drainage. Ann Thorac Surg 63:1676-84.nPridjian AK, Mendelsohn AM, Lupinetti FM, et al. 1993. Usefulness of bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 71:959-62.n
