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Glenn Shunt:Anaesthetic Concerns for a Non Cardiac Surgery


Affiliations
1 Department of Anesthesia and Critical Care, MAMC and Lok Nayak Hospital, New Delhi, India
2 Department of Cardiothoracic Vascular Surgery, AIIMS, New Delhi, India
 

Patients with single ventricle physiology have single chamber for pulmonary and systemic venous return that is supplied in parallel leading to cyanosis and ventricular volume overload. Palliative surgeries in the form of superior cavo-pulmonary anastomosis, also known as Bidirectional Glenn shunt (BDG) and complete cavo-pulmonary anastomosis, also known as Fontan procedure are done to divert blood from superior vena cava and inferior vena cava respectively into pulmonary circulation. As a result systemic and pulmonary blood flow run in series and forward flow is dependent on the relationship of systemic vascular resistance and pulmonary vascular resistance. Patients who have undergone Glenn shunt usually have peripheral oxygen saturation in the range of 75-85 % as a consequence of non-diversion of blood from inferior vena cava into pulmonary circulation. Fontan procedure is done in a staged manner to avoid sudden unloading of ventricle leading to failure. Anaesthesiologists encounter patients with Glenn shunt for non-cardiac surgery before they have undergone completion Fontan. A thorough understanding of Glenn and single ventricle physiology is required to deal with such patients and meticulous approach to anesthesia management is required after discussing with the surgeons and cardiologist, regarding the type of non-cardiac surgery, and to know the functional status of Glenn shunt. The present review article aims to discuss the anaesthesia concerns, and search of terms such as 'anaesthetic management', 'Glenn shunt', 'cavopulmonary anastomosis', 'Fontan procedure' was carried out in KKH eLibrary, Medline, PubMed, and Google scholar focusing on current research, randomized control trials, review articles and editorials.

Keywords

Cavopulmonary Anastomosis, Fontan Procedure, Glenn Shunt, Non-Cardiac Surgery.
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  • Glenn WW. Circulatory bypass of the right side of the heart. IV. Shunt between superiorvena cava and distal right pulmonary artery; report of clinical application. N Engl J Med. 1958; 259:117–20. crossref PMid:13566431

  • Azzolina G, Eufrate S, Pensa P. Tricuspid atresia, experience in surgical management with a modified cavopulmonary anastomosis. Thorax. 1972; 27(1):111–5. crossref PMid:5017561 PMCid:PMC472475

  • Fontan F, Baudet E. Surgical repair of tricuspid atresia. Thorax. 1971; 26:240–8. crossref PMid:5089489 PMCid:PMC1019078

  • Senzaki H, Masutani S, Kobayashi J, Kobayashi T, Sasaki N, Asano H, Kyo S, Yokote Y, Ishizawa A. Ventricular after load and ventricular work in fontan circulation: Comparison with normal two-ventricle circulation and single-ventricle circulation with blalock-taussig shunts. Circulation. 2002; 105:2885–92. crossref PMid:12070118

  • Tanoue Y, Sese A, Imoto Y, Joh K. Ventricular mechanics in the bidirectional glenn procedure and total cavopulmonary connection. Ann Thorac Surg. 2003; 76:562–6. crossref

  • Schwartz SM, Dent CL, Musa NL, Nelson DP. Single-ventricle physiology. Crit Care Clin. 2003; 19:393–411. crossref

  • Walker SG, Stuth EA. Single-ventricle physiology: perioperative implications. Semin Pediatr Surg. 2004; 13:188–202. crossref

  • Menghraj SJ. Anaesthetic considerations in children with congenital heart disease undergoing non-cardiac surgery. Indian Journal of Anaesthesia. 2012; 56:491–5. crossref PMid:23293389 PMCid:PMC3531005

  • Nakanishi T. Cardiac catheterization is necessary before bidirectional Glenn and Fontan procedures in single ventricle physiology. Pediatr Cardiol. 2005; 26:159–61. crossref PMid:15868324

  • Kakkar B, Agarwal M, Sehgal A, Govil NP. Anesthetic considerations for video‑assisted thoracoscopic surgery in a child with Glenn shunt for thoracic duct ligation and pleurodesis. Saudi Journal of Anaesthesia. 2018;12(1):131-133. crossref

  • Monteiro RS, Dob DP, Cauldwell MR, Gatzoulis MA. Anaesthetic management of parturients with univentricular congenital heart disease and the Fontan operation. Int J Obstet Anesth. 2016; 28:83–91. crossref PMid:27726918

  • Kohno M, Nagamine Y, Goto T. A Case of Undiagnosed Extra-adrenal Pheochromocytoma in an Adult Patient with Single Ventricle Circulation after the Bidirectional Glenn Operation. Masui. 2015; 64:985–8. PMid:26466501

  • Fernandes S, Suvarna D, Bhandarkar D. Anaesthetic implications in a child with Glenn’s Shunt undergoing dental procedure. Bombay Hospital Journal. 2011; 53:684–7.

  • Leyvi G, Wasnick JD. Single-ventricle patient: Pathophysiology and anesthetic management. J Cardiothorac Vasc Anesth. 2010; 24:121–30. crossref PMid:19864163

  • Maddali MM, Thomas E, Malik MM. Air embolism during fontan operation. Ann Card Anaesth. 2014; 17:229–31. crossref PMid:24994734

  • Mariano ER, Boltz MG, Albanese CT, et al. Anesthetic management of infants with palliated hypoplastic left heart syndrome undergoing laparoscopic Nissen Fundoplication. Anesth Analg. 2005; 100:1631–3. crossref PMid:15920186

  • Miura H, Kobayashi T, Suzuki K. Anesthetic management of an adult patient complicated with tricuspid atresia maladapted for fontan operation who underwent laparoscopic cholecystectomy. Masui. 2015; 64:416–20. PMid:26419108

  • Lofland G. The enhancement of hemodynamic performance in Fontan circulation using pain free spontaneous ventilation. Eur J Cardiothoracic Surg. 2001; 20:114–9. crossref


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  • Glenn Shunt:Anaesthetic Concerns for a Non Cardiac Surgery

Abstract Views: 270  |  PDF Views: 66

Authors

Bhavna Gupta
Department of Anesthesia and Critical Care, MAMC and Lok Nayak Hospital, New Delhi, India
Anish Gupta
Department of Cardiothoracic Vascular Surgery, AIIMS, New Delhi, India
Munisha Agarwal
Department of Anesthesia and Critical Care, MAMC and Lok Nayak Hospital, New Delhi, India
Lalit Gupta
Department of Anesthesia and Critical Care, MAMC and Lok Nayak Hospital, New Delhi, India

Abstract


Patients with single ventricle physiology have single chamber for pulmonary and systemic venous return that is supplied in parallel leading to cyanosis and ventricular volume overload. Palliative surgeries in the form of superior cavo-pulmonary anastomosis, also known as Bidirectional Glenn shunt (BDG) and complete cavo-pulmonary anastomosis, also known as Fontan procedure are done to divert blood from superior vena cava and inferior vena cava respectively into pulmonary circulation. As a result systemic and pulmonary blood flow run in series and forward flow is dependent on the relationship of systemic vascular resistance and pulmonary vascular resistance. Patients who have undergone Glenn shunt usually have peripheral oxygen saturation in the range of 75-85 % as a consequence of non-diversion of blood from inferior vena cava into pulmonary circulation. Fontan procedure is done in a staged manner to avoid sudden unloading of ventricle leading to failure. Anaesthesiologists encounter patients with Glenn shunt for non-cardiac surgery before they have undergone completion Fontan. A thorough understanding of Glenn and single ventricle physiology is required to deal with such patients and meticulous approach to anesthesia management is required after discussing with the surgeons and cardiologist, regarding the type of non-cardiac surgery, and to know the functional status of Glenn shunt. The present review article aims to discuss the anaesthesia concerns, and search of terms such as 'anaesthetic management', 'Glenn shunt', 'cavopulmonary anastomosis', 'Fontan procedure' was carried out in KKH eLibrary, Medline, PubMed, and Google scholar focusing on current research, randomized control trials, review articles and editorials.

Keywords


Cavopulmonary Anastomosis, Fontan Procedure, Glenn Shunt, Non-Cardiac Surgery.

References