Cavopulmonary anastomosis without cardiopulmonary bypass

Subperiosteal Orbital Hematoma From SVC Occlusion During Cardiac Surgery: To See or Not to See

We present a case in which the superior vena cava (SVC) cannula was inadvertently clamped for a short while during cardiopulmonary bypass, completely occluding SVC drainage. This resulted in a rarely seen complication - bilateral subperiosteal orbital hematomas causing orbital compartment syndrome. Other instances of intentional SVC occlusion include during the creation of a bidirectional cavo-pulmonary shunt and for emergency control of bleeding during thoracic surgery.

Early outcomes after the on pump bidirectional Glenn procedure: A single center experience

OBJECTIVE

Bidirectional Glenn procedure is a staged palliative procedure for patients with the univentricular hearts or complex congenital heart disease. We in our study, attempted to evaluate the preoperative characteristics, operative data and the early postoperative outcomes in the patients who underwent Bidirectional Glenn procedure at our center.

METHODS

In our single center retrospective experience, 115 patients underwent Bidirectional Glenn procedure from January 2015 to December 2019.

RESULTS

The mean age of the patients was 6.55 ± 6.5 years (range from 9 months to 48 years) and a median of 5 years. The most common anatomic diagnosis was double outlet right ventricle (n = 49, 42.6%). The primary diagnosis and the additional cardiac anamolies were not associated with the adverse outcomes. The increased cardiopulmonary bypass and operative time affect the postoperative outcomes. The median oxygen saturation in the patients postoperatively was 82%. The median postoperative stay was 8 days. The early postoperative complications were seen in 29 patients (25.2%). There were 12 early deaths (10.4%) in our study. The late age of presentation and poor preoperative nutrition, increased the risk of the postoperative morbidity and mortality.

CONCLUSION

Bidirectional Glenn procedure is an effective procedure to improve efficacy of the gas exchange and reduce volume overload on the single ventricle at early as well as late stages. However, the late age of presentation increases the risk of the postoperative outcomes.

Cerebral ventriculomegaly after the bidirectional Glenn (BDG) shunt: a single-institution retrospective analysis

PURPOSE

The bidirectional Glenn (BDG) procedure involves the anastomosis of the superior vena cava (SVC) to the pulmonary artery, increasing central venous pressure (CVP). We hypothesize that this increase in CVP triggers an acute neurologic insult, leading to ventriculomegaly.

METHODS

In this retrospective analysis in a tertiary care children's hospital, we identified 167 patients who underwent the BDG procedure between August 2006 and July 2013. Within this initial cohort, 24 patients had head imaging (CT, MRI, or ultrasound) performed both before and after the BDG.

RESULTS

From head imaging available from these 24 patients, we measured the frontal-occipital horn ratio (FOR), a well-validated measure of lateral ventricle size. Using central venous catheter data, we assessed postoperative CVP at 12, 24, and 48 h. Paired t tests and linear regression were used to evaluate our cohort. Median age at surgery was 4.9 months. Paired analysis revealed that median FOR significantly increased between preoperative (median 0.38, IQR 0.37-0.41) and postoperative (median 0.42, IQR 0.40-0.45) head images (p = 0.005). Increasing change in FOR was associated with increased 12-h (R(2) = 0.369, p = 0.003) but not 24- or 48-h postoperative CVP.

CONCLUSIONS

To our knowledge, our study is the first to demonstrate ventriculomegaly developing after the BDG. Physiologically, increasing CVP after the BDG was associated with greater change in lateral ventricle size. This supports the contention that increasing CVP produced during the BDG may damage the developing brain. This study has informed a prospective evaluation of a link between the BDG procedure and neurologic outcomes.