A Modified Technique of Venoatrial Bypass in Bidirectional Glenn Shunt

Abstract

Clamping of the superior vena cava, while constructing a bidirectional Glenn shunt in patients with a single superior vena cava, may lead to an unacceptable rise in proximal venous pressure. Between January 1993 and March 1994, 7 patients underwent bidirectional Glenn shunt at our institution. Of these 7, 4 had a single superior vena cava and required venoatrial bypass. This was carried out with interposition of a roller pump. Central venous pressure was maintained at 13 to 30 mm Hg (mean 23.5 mm Hg) and arterial pressure at 60 to 74 mm Hg (mean 64 mm Hg). Postoperatively, no facial edema or neuropsychological disturbance was detected. This modified method is more effective than simple venoatrial bypass and less extensive than a cardiopulmonary bypass.