Posts Tagged ‘Glenn Procedure’

What really happened

November 25, 2009

Back in August I blogged about faxing a HIPPA compliance form to Johns Hopkins Hospital to get some medical records from my 1967 heart surgery. I already had the records, actually, but I had managed to misplace several of them. So I filled out another compliance form and faxed it to the Medical Records office.

Hopkins responded by sending all of my medical records from that first surgery, not just the 12 sheets I already had. I returned to Hopkins several times for check ups until I was about five years old, but none of those records are included. So now instead of 12 sheets, my stack is about an inch thick. This was a lot more information than I expected, and every bit of it is interesting.

I have Catherization reports, – one of which destroys a family legend; I always thought that we arrived at Hopkins at roughly 10:30 PM, but the Cath report says that I was brought into the Cath Lab at 6:16 PM. Daddy says we arrived at Hopkins about 3:30 pm, and the surgery itself began at 10:30 PM.

There are Radiological reports but no X-rays. I wonder if they deteriorate over the years. Possibly they are filed away in a different place, since all my records are copies, most likely made from microfilm.

Quite a few pages of Nurse’s reports (I can – and probably will – make an entire post about those!) and –

Oh my goodness…

The title of the sheet is OPERATING ROOM REPORT. And this is the entire report, not just the summary and the little bits and pieces of my operation that I assume from what I already know.

After the temperature was down to 32 degrees we used inflow stasis and during a three-minute period of inflow stasis dissected a sizable portion of the Atrial Septum.

I was too small for the heart/lung machine, so the surgical team stopped my heart temporarily by hypothermia – They literally put me in ice and cooled me until my heart stopped. During a three minute period of no blood flow doctors cut into my heart and enlarge an Atrial Septal Defect (ASD). For the heart to work (and its owner to survive) blood has to be able to complete the Cardiopulmonary circuit: flow from the body into the heart, move from the heart to the lungs, then back to the heart, and once again out to the body.¬† Because my normal pathway is blocked my blood “escapes” through an Atrial Septal Defect (ASD), and that earlier Catherization had revealed that my ASD wasn’t quite big enough.

…at the end of this part of the operation we proceeded to prepare the vessels for a right Pulmonary Artery anastomosis after the technique of Glenn.

This is a phrase that I type often and Funky Heart readers are probably tired of seeing: I don’t have the Glenn Procedure that is currently in use. That’s known as the Bi-Directional Glenn, because blood is rerouted to both lungs. I have the original version of the operation, the “Classic Glenn” or sometimes called the Unidirectional Glenn. In my version, the right branch of the Pulmonary Artery is cut and sewn into the Superior Vena Cava, so the majority of my blood flows into my right lung. CLICK HERE to see the best drawing I have ever seen of the Classic Glenn Procedure.

Chest was closed in layers with #00 catgut and skin with Dermalon. The patient tolerated the procedure well.

(Signed)

Vincent Gott, M.D.

Wow. Just…wow.

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!