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When the Bidirectional Glenn is an Unfavorable Option: Primary Extracardiac Inferior Cavopulmonary Connection as an Alternative Palliation
Originally presented as a Surgical Motion Picture at the 2015 STSA Annual Meeting
Objectives: The superior vena cava-pulmonary artery connection (bidirectional Glenn) is the standard palliation for single ventricle physiology. When upper body systemic venous anatomic concerns such as superior vena cava stenosis, hypoplasia, or inadequate collateral tributaries are present, a Glenn may be precluded or have a high risk of poor outcome.
Methods: A primary inferior cavopulmonary connection with an extracardiac conduit is presented as an alternative palliation that provides a generous pathway for pulmonary blood flow, with the additional benefit of including hepatic venous return. This video shows a case of primary extracardiac inferior cavopulmonary connection in an infant unsuitable for Glenn.
Results: The post-operative course was uneventful, and the patient was discharged on day 8. The follow-up exam at 5 months was satisfactory with angiographically-documented connection patency, and no veno-venous collaterals or hepatic vein congestion. The infant had oxygen saturations in the mid-80's, no ascites, and was feeding and gaining weight normally.
Conclusion: With suboptimal upper body systemic venous anatomy, the primary extracardiac inferior cavopulmonary connection was an alternative palliation with a safe early outcome in the patient, clinically similar to that after a bidirectional Glenn. More studies and longer follow-up are needed to determine its longevity and perhaps expand its indications.
Copyright 2015, used with permission from the Southern Thoracic Surgical Association. All rights reserved.