Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bid...Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bidirectional cavopulmonary anastomosis were enrolled the study. The number, shape, size, origin and entry, and course of collateral vessels from left superior vena cava were referred for evaluation based on 41 cardiac angiographies. The influential factors on the formation of collateral vessels were identified by binary logistic regression analysis. Results: The number of the left superior vena cava with collateral vessels was larger than right one, 22 versus 8 (X2 = 10.303, P = 0.001). The medium-distal parts of left systemic vena were prone to development of collateral channel. The logic function with respect to the probability of left systemic venous collateral channel could be expressed as the linear expression of left systemic venous pressure x: 0.418x ?7.111 (X2 = 23.095, P Setting 17.0 mmHg of left systemic venous pressure as prediction cut-point to discriminate the occurrence of left collateral vessels, the predictive accuracy reached 85.7%. Conclusions: The left systemic venous pressure was an independent factor associated with left systemic venous collateral channel after bilateral bidirectional cavopulmonary shunt. It might be practically feasible to predict the development of collateral vessels according to systemic venous pressure.展开更多
Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited eviden...Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC g展开更多
The bidirectional Glenn procedure is an integral step in the optimal palliation for single ventricular physiology in many forms of complex congenital heart disease. An increasing number of women who have undergone thi...The bidirectional Glenn procedure is an integral step in the optimal palliation for single ventricular physiology in many forms of complex congenital heart disease. An increasing number of women who have undergone this connection in childhood are now reaching childbearing years. Low pulmonary blood flow and volume over load on the single ventricle pose several problems during pregnancy. We are reporting a 33-year-old lady with congenital tricuspid atresia and mild pulmonary stenosis who had late Bidirectional Glenn procedure with pulmonary forward flow and later underwent six successful pregnancies, with delivery of six low birth weight babies with no reported complications.展开更多
Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are perfor...Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are performed at an older age than that recommended by the literature.So,we aim to assess post bidirectional Glenn shunt patients to detect the presence of any complications and to evaluate their functional capacity.Methods:This was a descriptive study that included all patients who underwent a bidirectional Glenn shunt and were referred for follow up in Ain shams university hospitals.History taking including NYHA class and physical activity,clinical examination,six-minutes-walk test,laboratory investigations,full echocardiographic assessment were done for all patients.Some patients needed invasive cardiac catheterization.Results:Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.The mean age of the registry was 18.7±8.26 years(range between 5 and 37 years),85 males(48%)and 93 females(52%).Regarding the basic anatomy,double outlet right ventricle with hypoplastic left ventricle was the commonest.Furthermore,our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries.Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to other studies that have been made in developing countries like Pakistan,India and Iran.There is a significant delay in the operation in Egyptian patients due to lack of patients’awareness,few numbers of primary health care facilities and high economic burden.Conclusion:Although the presence of slight systemic desaturation,our study demonstrated a satisfactory functional capacity among our patients;thus,bidirectional Glenn can be considered an acceptable definite univentricular repair in patients with late presentation.展开更多
INTRODUCTION Single ventricle is one type of infrequent and complex congenital heart disease. Bidi- rectional Glenn shunt operation is becoming the most common and effective palliative op- eration of single ventricle...INTRODUCTION Single ventricle is one type of infrequent and complex congenital heart disease. Bidi- rectional Glenn shunt operation is becoming the most common and effective palliative op- eration of single ventricle to improve the symptoms before modified Fontan operation. However, Bidirectional Glenn shunt opera- tion is rarely applied to the adult patient （more than 20 years old） with single ventri- cle because of the low survival rate1. In this report, we presented a six years following-up study of the Bidirectional Glenn shunt in a 37-year-old female patient with single ventricle.展开更多
It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart di...It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.展开更多
Glenn W.Taylor是英国Stocks Taylor Benson设计工作室(下文简称STB)的联合创始人及现任CEO,曾担任两届英国特许设计师协会副会长,拥有趄过36年平面设计及创意指导经验。多年来除了设计工作外,他还长期在设计院校担任客座教授,讲授设计...Glenn W.Taylor是英国Stocks Taylor Benson设计工作室(下文简称STB)的联合创始人及现任CEO,曾担任两届英国特许设计师协会副会长,拥有趄过36年平面设计及创意指导经验。多年来除了设计工作外,他还长期在设计院校担任客座教授,讲授设计课程、审阅和认证本科及硕士课程论文,担任众多专业设计大奖评审。此外,他还为其它专业机构(包括自己的同行和潜在竞争对手)慷慨地提供关于优化设计的建议。展开更多
The differential diagnosis for irritability in children is broad.In patients with congenital heart disease,one must strongly consider cardiac etiologies such as low cardiac output or elevated central venous pressure(C...The differential diagnosis for irritability in children is broad.In patients with congenital heart disease,one must strongly consider cardiac etiologies such as low cardiac output or elevated central venous pressure(CVP).In patients with single-ventricle physiology,the second stage of palliation includes bidirectional Glenn,which involves anastomosis of the superior vena cava to the pulmonary artery resulting in volume offloading of the single systemic ventricle.Typically,early in the post-operative period,patients may experience a headache due to the acute increase in CVP,and symptoms improve over time.Idiopathic intracranial hypertension(IIH),also known as pseudotumor cerebri,is a rare neurologic disorder in children,characterized by raised intracranial pressure(ICP)in the absence of brain parenchymal lesions or cerebrospinal fluid(CSF)abnormalities.While the pathogenesis of IIH is unknown,early recognition and treatment of IIH are important to prevent permanent vision loss.There are only rare reports of IIH in patients with Fontan circulation.To our knowledge,we report the first case of IIH in a 2-year-old female after bidirectional Glenn.展开更多
文摘Objectives: To analyze and predict collateral channels in bilateral bidirectional cavopulmonary anastomosisfocused on that from left superior vena cava. Methods: 41 consecutive patients who all underwent bilateral bidirectional cavopulmonary anastomosis were enrolled the study. The number, shape, size, origin and entry, and course of collateral vessels from left superior vena cava were referred for evaluation based on 41 cardiac angiographies. The influential factors on the formation of collateral vessels were identified by binary logistic regression analysis. Results: The number of the left superior vena cava with collateral vessels was larger than right one, 22 versus 8 (X2 = 10.303, P = 0.001). The medium-distal parts of left systemic vena were prone to development of collateral channel. The logic function with respect to the probability of left systemic venous collateral channel could be expressed as the linear expression of left systemic venous pressure x: 0.418x ?7.111 (X2 = 23.095, P Setting 17.0 mmHg of left systemic venous pressure as prediction cut-point to discriminate the occurrence of left collateral vessels, the predictive accuracy reached 85.7%. Conclusions: The left systemic venous pressure was an independent factor associated with left systemic venous collateral channel after bilateral bidirectional cavopulmonary shunt. It might be practically feasible to predict the development of collateral vessels according to systemic venous pressure.
基金funded by the grants from the National Key R&D Program of China(No.2016YFC1100300)the Guangdong Science and Technology Project,China(No.2015B070701008)
文摘Background The bidirectional Glenn shunt surgery is a palliative procedure for patients with complex congenital heart disease（CHD） who are not suitable for biventricular repair in early life. There is limited evidence of successful strategies for long-term hemodynamic stabilization. Furthermore, there have been no data on optimal hemodynamics that could be used as a reference for patients＇ follow-on management. Methods Sixty CHD patients, 44 male and 16 female, with bidirectional Glenn shunt surgery and cardiac catheterization were enrolled at our hospital between January 2014 and December 2016. Pre-and post Glenn shunt percutaneous oxygen saturation（SpO_2）, 6-minute walk test（6 MWT）, superior vena cava pressure（SVCP）, pulmonary arterial pressure（PAP）, pulmonary capillary wedge pressure（PCWP）, pulmonary vascular resistance（PVR）, small pulmonary vascular resistance（s PVR） were measured. Pre-and post-total cavopulmonary connection（TCPC） SpO_2, and in-hospital complications were monitored. The optimal hemodynamic cutoff values for TCPC patient selection were estimated by receive operating characteristic（ROC） curve analysis. Results SpO_2 was significantly increased by bidirectional Glenn shunt surgery（75.42 ± 9.62% to 86.98 ± 7.63%, P 〈 0.001） from 82.70 ± 5.99% to 95.00 ±4.07% in the 47 patients with TCPC. Forty-two patients completed the 6 MWT with a mean distance of 362.7 ±75.0 m and a SpO_2 decrease from 81.80 ± 7.84% to 67.59 ± 1.82%（P 〈 0.001）. The △SpO_2 and 6-minute walk distance（6 MWD） in the 32 who underwent TCPC and ten of them did not reach statistical significance（17.22 ±13.82% vs. 13.87 ± 8.74%, P = 0.08 and 358.88 ± 78.97 m vs. 374.80 ± 62.55 m, P = 0.564]. After cardiac catheterization, 47 patients were selected for TCPC. The right pulmonary artery systolic pressure（s RPAP）, mean right pulmonary artery pressure（m RPAP）, mean left pulmonary artery pressure（m LPAP）, PVR, and s PVR were significantly lower in the TCPC g
文摘The bidirectional Glenn procedure is an integral step in the optimal palliation for single ventricular physiology in many forms of complex congenital heart disease. An increasing number of women who have undergone this connection in childhood are now reaching childbearing years. Low pulmonary blood flow and volume over load on the single ventricle pose several problems during pregnancy. We are reporting a 33-year-old lady with congenital tricuspid atresia and mild pulmonary stenosis who had late Bidirectional Glenn procedure with pulmonary forward flow and later underwent six successful pregnancies, with delivery of six low birth weight babies with no reported complications.
基金The study was approved by Research Ethics Committee at the Faculty of Medicine Ain Shams University(FWA 000017585).Approval No.FMASU M D 65/2019.
文摘Background:Bidirectional Glenn shunts have long been available as palliative procedures for patients with single ventricle physiology that is,patients unsuitable for biventricular repair.In our country they are performed at an older age than that recommended by the literature.So,we aim to assess post bidirectional Glenn shunt patients to detect the presence of any complications and to evaluate their functional capacity.Methods:This was a descriptive study that included all patients who underwent a bidirectional Glenn shunt and were referred for follow up in Ain shams university hospitals.History taking including NYHA class and physical activity,clinical examination,six-minutes-walk test,laboratory investigations,full echocardiographic assessment were done for all patients.Some patients needed invasive cardiac catheterization.Results:Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.The mean age of the registry was 18.7±8.26 years(range between 5 and 37 years),85 males(48%)and 93 females(52%).Regarding the basic anatomy,double outlet right ventricle with hypoplastic left ventricle was the commonest.Furthermore,our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries.Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to other studies that have been made in developing countries like Pakistan,India and Iran.There is a significant delay in the operation in Egyptian patients due to lack of patients’awareness,few numbers of primary health care facilities and high economic burden.Conclusion:Although the presence of slight systemic desaturation,our study demonstrated a satisfactory functional capacity among our patients;thus,bidirectional Glenn can be considered an acceptable definite univentricular repair in patients with late presentation.
文摘INTRODUCTION Single ventricle is one type of infrequent and complex congenital heart disease. Bidi- rectional Glenn shunt operation is becoming the most common and effective palliative op- eration of single ventricle to improve the symptoms before modified Fontan operation. However, Bidirectional Glenn shunt opera- tion is rarely applied to the adult patient （more than 20 years old） with single ventri- cle because of the low survival rate1. In this report, we presented a six years following-up study of the Bidirectional Glenn shunt in a 37-year-old female patient with single ventricle.
文摘It is very important to understand that the univentricular heart surgery is just palliative, not being in anyway a definitive or curative surgery, but nowadays it’s the best initial treatment of this complex heart disease. The fundamental philosophy of treatment of every univentricular heart is to ensure the flow system and/or restrict the lung flow. Thus, initially a patient with univentricular heart who is undergoing surgery may need to ensure systemic flow (reconstruction of the aortic?arch type Norwood), to restrict the lung flow (pulmonary banding) or to provide enough?pulmonary flow (pulmonary-systemic fistulae). However, some heart diseases with univentricular physiology remain “balanced” autonomously, until the “second” stage of palliation is performed (cavo-pulmonary anastomosis type Glenn), but others require performance of pulmonary banding, if there’s no native lung protection and/or repair of the systemic circuit in a first stage, to reach next palliation steps in the best possible conditions.
文摘Glenn W.Taylor是英国Stocks Taylor Benson设计工作室(下文简称STB)的联合创始人及现任CEO,曾担任两届英国特许设计师协会副会长,拥有趄过36年平面设计及创意指导经验。多年来除了设计工作外,他还长期在设计院校担任客座教授,讲授设计课程、审阅和认证本科及硕士课程论文,担任众多专业设计大奖评审。此外,他还为其它专业机构(包括自己的同行和潜在竞争对手)慷慨地提供关于优化设计的建议。
文摘The differential diagnosis for irritability in children is broad.In patients with congenital heart disease,one must strongly consider cardiac etiologies such as low cardiac output or elevated central venous pressure(CVP).In patients with single-ventricle physiology,the second stage of palliation includes bidirectional Glenn,which involves anastomosis of the superior vena cava to the pulmonary artery resulting in volume offloading of the single systemic ventricle.Typically,early in the post-operative period,patients may experience a headache due to the acute increase in CVP,and symptoms improve over time.Idiopathic intracranial hypertension(IIH),also known as pseudotumor cerebri,is a rare neurologic disorder in children,characterized by raised intracranial pressure(ICP)in the absence of brain parenchymal lesions or cerebrospinal fluid(CSF)abnormalities.While the pathogenesis of IIH is unknown,early recognition and treatment of IIH are important to prevent permanent vision loss.There are only rare reports of IIH in patients with Fontan circulation.To our knowledge,we report the first case of IIH in a 2-year-old female after bidirectional Glenn.
