Name of the Procedure:

Shunt; superior vena cava to pulmonary artery for flow to both lungs (Bidirectional Glenn procedure)

Summary

The Bidirectional Glenn procedure is a type of heart surgery performed on children with certain congenital heart defects. It involves connecting the superior vena cava, a large vein that carries blood from the upper body, directly to the pulmonary arteries, which carry blood to both lungs. This helps improve blood flow to the lungs and reduces the workload on the heart.

Purpose

The procedure is designed to treat congenital heart defects where the heart cannot effectively pump blood to the lungs. By connecting the superior vena cava to the pulmonary artery, the procedure aims to improve oxygenation of the blood and reduce the strain on the heart, ultimately improving the child's overall circulation and health.

Indications

• Single ventricle defects.
• Hypoplastic left heart syndrome.
• Tricuspid atresia.
• Other congenital heart anomalies that impede normal blood flow to the lungs.

Preparation

• Patients are usually instructed to fast for several hours before the procedure.
• Adjustment or temporary discontinuation of certain medications may be necessary.
• Pre-procedure diagnostic tests such as echocardiograms, MRI, or cardiac catheterization are often required to assess heart function and anatomy.

Procedure Description

1. The patient is administered general anesthesia to ensure sleep and pain-free experience.
2. The surgeon makes an incision in the chest to access the heart and major blood vessels.
3. The superior vena cava is carefully detached from the right atrium of the heart.
4. The superior vena cava is connected to the pulmonary arteries, allowing blood to flow directly to the lungs.
5. The chest is then closed, and the patient is taken off bypass, with all incisions sutured.

Duration

The procedure typically takes about 3 to 4 hours.

Setting

The Bidirectional Glenn procedure is performed in a hospital, usually in a specialized cardiac surgery operating room.

Personnel

• Cardiothoracic surgeon
• Pediatric cardiologist
• Anesthesiologist
• Surgical nurses
• Perfusionist (responsible for the heart-lung machine)

Risks and Complications

• Bleeding
• Infection
• Heart rhythm problems
• Fluid buildup around the lungs or heart
• Rarely, a stroke or heart attack

Benefits

• Improved blood oxygenation
• Decreased workload on the heart
• Enhanced quality of life and physical capabilities
• Most benefits can be realized within weeks after the procedure.

Recovery

• Post-procedure monitoring in the intensive care unit (ICU) for a few days.
• Gradual return to normal activities under medical guidance.
• Follow-up appointments with the cardiologist.
• Restrictions on strenuous activities for a few weeks to months.
• Pain management with prescribed medications.

Alternatives

• Fontan procedure, which is often performed later as a staged approach for the same conditions.
• Heart transplant in severe cases.
• Each alternative has its own set of risks and benefits; for instance, the Fontan procedure is another surgical step for better long-term outcomes but is more complex.

Patient Experience

• Patients may feel drowsy and sore immediately after the procedure due to anesthesia and the chest incision.
• Pain management is provided through medications.
• Regular follow-ups ensure that recovery is on track and address any complications or concerns promptly.