Post-Glenn Shunt Systemic Desaturation—Is Venovenous Collateral the Culprit?
After classic Glenn shunt or bidirectional cavopulmonary anastomosis, the reappearance or deepening of cyanosis may be due to systemic venous collateral channels. There are only few case reports on this issue in the present literature. Here, we present two cases that underwent bidirectional Glenn shunt, who later presented with cyanosis and desaturation and both of them were found to have venovenous collaterals.
Keywordsvenovenous collaterals - glenn shunt - pericardioprenic collaterals - intercostobronchial collaterals
13 July 2020 (online)
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- 1 Reddy VM, Liddicoat JR, Hanley FL. Primary bidirectional superior cavopulmonary shunt in infants between 1 and 4 months of age. Ann Thorac Surg 1995; 59 (05) 1120-1125, discussion 1125–1126
- 2 Hopkins RA, Armstrong BE, Serwer GA, Peterson RJ, Oldham Jr HN. Physiological rationale for a bidirectional cavopulmonary shunt. A versatile complement to the Fontan principle. J Thorac Cardiovasc Surg 1985; 90 (03) 391-398
- 3 Bridges ND, Jonas RA, Mayer JE, Flanagan MF, Keane JF, Castaneda AR. bidirectional cavopulmonary anastomosis as interim palliation for high-risk Fontan candidates. Early results. Circulation 1990; 82 (Suppl. 05) IV170-IV176
- 4 Pridjian AK, Mendelsohn AM, Lupinetti FM. et al. Usefulness of the bidirectional Glenn procedure as staged reconstruction for the functional single ventricle. Am J Cardiol 1993; 71 (11) 959-962
- 5 Graham AJ, Ricketts HJ, Fenn JE, Larsen PB, Cev M, Glenn WW. Further experiments on long term survivors after circulatory bypass of the right side of the heart. Surg Gynecol Obstet 1964; 119: 302-310
- 6 Mathur M, Glenn WW. Long-term evaluation of cava-pulmonary artery anastomosis. Surgery 1973; 74 (06) 899-916
- 7 Trusler GA, Williams WG, Cohen AJ. et al. William Glenn lecture. The cavopulmonary shunt. Evolution of a concept. Circulation 1990; 82 (Suppl. 05) IV131-IV138
- 8 Gatzoulis MA, Shinebourne EA, Redington AN, Rigby ML, Ho SY, Shore DF. Increasing cyanosis early after cavopulmonary connection caused by abnormal systemic venous channels. Br Heart J 1995; 73 (02) 182-186
- 9 Bernstein HS, Brook MM, Silverman NH, Bristow J. Development of pulmonary arteriovenous fistulae in children after cavopulmonary shunt. Circulation 1995; 92 (Suppl. 09) II309-II314
- 10 Triedman JK, Bridges ND, Mayer Jr JE, Lock JE. Prevalence and risk factors for aortopulmonary collateral vessels after Fontan and bidirectional Glenn procedures. J Am Coll Cardiol 1993; 22 (01) 207-215
- 11 Bernstein HS, Ursell PC, Brook MM, Hanley FC, Silverman NH, Bristow J. Fulminant development of pulmonary arteriovenous fistulas in an infant after total cavopulmonary shunt. Pediatr Cardiol 1996; 17 (01) 46-50
- 12 de Leval MR, Dubini G, Migliavacca F. et al. Use of computational fluid dynamics in the design of surgical procedures: application to the study of competitive flows in cavo-pulmonary connections. J Thorac Cardiovasc Surg 1996; 111 (03) 502-513
- 13 Van Haesdonck JM, Mertens L, Sizaire R. et al. Comparison by computerized numeric modeling of energy losses in different Fontan connections. Circulation 1995; 92 (Suppl. 09) II322-II326
- 14 Perry SB, Radtke W, Fellows KE, Keane JF, Lock JE. Coil embolization to occlude aortopulmonary collateral vessels and shunts in patients with congenital heart disease. J Am Coll Cardiol 1989; 13 (01) 100-108