Novel techniques of bidirectional Glenn shunt without cardiopulmonary bypass

Background. We report novel techniques of performing bidirectional Glenn sh unt (BDG) without cardiopulmonary bypass (CPB). Methods. Five cases of single ventricle and pulmonary stenosis (PS) complex were taken up for BDG without CPB. The criteria for case selection were an unrestrictive atrial septal defect (ASD), no atrioventricular (AV) valve r egurgitation, and no other intracardiac defects requiring correction. A tem porary shunt was established between the superior vena cava (SVC) and contr alateral branch pulmonary artery (PA) for venous drainage during SVC clampi ng for BDG anastomosis in four cases. In case 5, a shunt was put between th e SVC and right atrium (RA) for venous drainage, and modified Blalock Tauss ig shunt and patent ductus arteriosus (PDA) were left open until the comple tion of the BDG. Results. Central venous pressure (CVP) increased to a mean of 22.4 mm Hg du ring SVC clamping, with improvement of oxygen (O-2) saturation from 62.4% t o 82.4%. After Glenn shunt, CVP and O-2 saturation maintained at 13.2 mm Hg and 87.4%, respectively. Postoperatively, there were no neurological abnor malities and no hospital mortality. Conclusions. Our technique provides an excellent venous drainage with impro vement of O-2 saturation during SVC clamping. It avoids problems related to CPB and economy. It is easily reproducible, with excellent results in a se lected group of patients without compromising the completeness of repair. ( C) 1999 by The Society of Thoracic Surgeons.