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Experience with the Glenn anastomosis in the adult with cyanotic congenital heart disease

Published online by Cambridge University Press:  19 August 2008

Amalia Elizari  and
Jane Somerville
Amalia Elizari
Affiliation:
Jane Somerville Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
Jane Somerville*
Affiliation:
Jane Somerville Grown-up Congenital Heart Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, UK
*
Dr Jane Somerville, 81/83 Harley Street, London W1N 1DE, UK. Tel: 0171 299 9407; Fax: 0171 299 9409
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Abstract

A clinical study on the outcomes of Glenn anastomoses performed since 1987 in eight consecutive patients aged ≥16 years, and in two performed earlier, showed poor results. One badly selected patient died early as a consequence of high venous pressure, while a further seven had early complications. Seven of eight hospital survivors were followed for 1–10 (median 4.2) years with two deaths (1 and 4 years later). Of the remaining five patients, two improved temporarily, but increased arterial oxygen saturation was not maintained after 6 months. The two patients who had undergone a Glenn anastomosis 10 and 34 years earlier were shown to have pulmonary arteriovenous fistulas. The Glenn anastomosis in these older patients is associated with high rates of complication and appears not to give adequate palliation, particularly when it is the only source of pulmonary blood supply. In the adult, the Glenn anastomosis can be used as a staging procedure for Fontan-type surgery, but must be combined with another source of pulmonary arterial supply. Any adult having a Glenn anastomosis, particularly without another source of pulmonary arterial supply, should be warned of the possibility of worsening of cyanosis and symptoms. The second stage of the procedure may need to be performed soon after the first should the hypoxia prove intolerable.

Keywords

Glenn anastomosisgrown-up congenital heart disease
Type
Original Articles
Information
Cardiology in the Young , Volume 9 , Issue 3 , May 1999 , pp. 257 - 265
Copyright
Copyright © Cambridge University Press 1999

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