Posts Tagged ‘Bidirectional Glenn’

The Glenn Shunt

July 17, 2009

One of the more familiar operations used by Congenital Cardiac surgeons is the Glenn Shunt (Also known as the Glenn Procedure, the word “Shunt” means “detour”.) Despite being revised from its original form and falling out of favor for a time, the Glenn is often used in the repair of defective hearts.

Developed by Dr. William Glenn in the 1950’s, the original operation may not be recognized¬† by today’s doctors. In what is now known as the Classic Glenn or the Unidirectional Glenn, the Superior Vena Cava (SVC) would be sewn closed near its junction with the Right Atrium. The Right Pulmonary Artery (RPA) is then cut and sewn into the SVC, and the open end of the Pulmonary Artery would be sewn closed. In this configuration, the Glenn Shunt only sends blood to the right lung. Here’s a good diagram of the Classic Glenn Shunt and here’s what I think is an even better drawing. The second link contains links to important information about both versions of the Glenn, worth your time to read. For the record, my first heart operation in 1967 was the Classic Glenn Shunt.

The Glenn fell out of favor after the Fontan Procedure was introduced. After years of neglect (I was told in 1977 by a surgical assistant that “we rarely do the Glenn any more”) it was looked at again when the early versions of the Fontan tended to not deliver the expected results. By then the operation had evolved into the Bidirectional Glenn Shunt. In the Bidirectional Glenn, the Superior Vena Cava is cut, and then re-sewn into the Right Pulmonary Artery. This is makes it bidirectional, as blood now flows to both lungs. Here’s a good photo of the Bidirectional Glenn (.pdf file) and here is a .pdf report on modeling a Bidirectional Glenn to study it’s affects on the individual patient. This report may appeal more to readers with a mathematical background, as the first part of the article is a complex discussion of the formulas needed to create the model.

Currently, the Bidirectional Glenn Shunt can be used as an option to repair most of the right-sided heart defects. It is also the second operation of the Norwood Procedure to repair Hypoplastic Left Heart Syndrome. (HLHS) It was first used in the Norwood in 1989; until then, the Norwood repair was a two surgery procedure.

And finally, here is a visual reminder to learn the anatomy of the heart yourself and not trust everything you find on the Internet: The text on this page correctly describes the Bidirectional Glenn Shunt, but the illustration is of a Blalock-Taussig Shunt!

8/2/2009 Update: I listed the same link twice when referring to two drawings of the Glenn Shunt! That has been corrected!

Better Surgery!

June 1, 2009

Here’s an interesting report from the March 2006 issue of Heart: A look at the outcomes of surgical correction for Hypoplastic Left Heart Syndrome, or HLHS. What makes this report so unusual is that it covers twelve years at the same hospital: While surgeons, doctors, and nurses come and go, the hospital policies and standards of care stay in place and hopefully improve. So this can be considered an unbiased study. When results from more than one facility is used, the results can be affected by a hospital that has more (or less) successful results than average.

Beginning in 1992, 333 patients underwent the Stage I surgical correction for HLHS, also known as the Norwood procedure. 203 patients underwent the Stage II operation (the Bidirectional Glenn), and 81 had the Fontan Procedure (Stage III). While HLHS is difficult to overcome, the report does not elaborate on the difference in numbers. It is quite possible that patients had their Stage II or Stage III operations at different facilities.

Over the course of the study, mortality after the Stage I operation dropped from 46% during the first year (1992) to just 16% in the last year (2004). The survival rate jumped dramatically in 2002, when the Stage I was altered: the Modified Blalock-Taussig Shunt that was part of the operation was replaced by a Right Ventricle to Pulmonary Artery Conduit.

Medical research is a long, tedious assignment – there are very few “bolt of lightning” moments and it often requires gathering massive amounts of data. But it works, and is often the only way to learn if a new theory is both effective and safe.

Eli and Me

February 16, 2009

Good news from Lisa, who’s son Eli had surgery on Monday, February 9: Eli is doing great! Surgeons closed his ASD, resceted a “blob” of extra tissue near the Pulmonary Artery, and then performed the Bi-directional Glenn. Everything went well and Eli was discharged three days later! (And I get to tell you again that the drawing on the Glenn Operation page is not the Bi-directional Glenn… it’s the Unidirectional Glenn, sometimes called the Classic Glenn. It’s the operation that I have!)

February 9 is going to be your second birthday, Eli. Trust me on this one, I know. Because I’m coming up on my second birthday:¬† On February 17, 1967, I had my first heart surgery.

“He’s down to hours,” Cardiologist Richard Rowe told my parents that Friday night. “We need to go to surgery right now.” Afterwards I was in the hospital three weeks; Eli only had to stay three days. Three days – times sure have changed!

You probably won’t see a post on my second birthday, since I’m traveling. I’ll be heading to Atlanta, where on Wednesday morning my Cardiologist will put his stethoscope to my chest and hear that Classic Glenn Shunt just chuggin’ along.

So Happy (second) Birthday, Eli! And I hope you have many, many more!

Your buddy;

The Funky Heart

Red and Blue Pride!

November 24, 2008

Alfred Blalock (Alan Rickman) and Helen Taussig (Mary Stuart Masterson) in HBO's Something the Lord Made

Alfred Blalock (Alan Rickman) and Helen Taussig (Mary Stuart Masterson)

Still from HBO’s Something the Lord Made

Saturday (November 29) is the 64th anniversary of the Blalock-Taussig Shunt. It’s our birthday, and I think we should celebrate.

All of you are not invited over to my house – I don’t think I have a big enough cake – so you’re going to have to party by yourselves. “But wait a moment,” you may say, “my operation wasn’t a Blalock-Taussig. It was a Waterston Shunt, or a Bidirectional Glenn, or the Norwood.”

Doesn’t matter.

Because the Blalock-Taussig operation was the first surgery designed to relieve the effects of a Congenital Heart Defect. Without Dr. Blalock and Dr. Taussig, there is no heart surgery. And without heart surgery… we aren’t here. So it doesn’t matter if you’ve never had the Blalock-Taussig Shunt; if you have a Congenital Heart Defect and have survived an operation, this is your event, too.

To celebrate, I’m wearing Red and Blue on Saturday. I was blue (Cyanotic) and now I’m red… or at least, an acceptable shade of pink. Why don’t you do the same? Ask your friends to wear the colors, also.

I’m also wearing my Adult Congenital Heart Association (ACHA) pin. If you are a member of a CHD support group, make sure you put yours on, too. I’ll lose my ACHA lapel pin in a moment, so I usually leave it attached to my suit jacket; but I’m wearing it Saturday. Wear yours. If you have an extra pin, give it to someone you care about, or who cares about you.

Call every Heart Dad and Heart Mom you know, along with fellow Heart Warriors and get them involved. Let them know what you are doing and why – and tell them to pass the word. 1 in 125 people have a heart defect, let the world know how many of us that there really are!

A Congenital Heart Defect is an “unseen disability” – the general public will never know what we put up with. Instead of whining and complaining, we just want to do the best we can and be happy and productive citizens. We usually don’t draw attention to ourselves… but on Saturday, we need to brag a little!