Glenn with additional sources of pulmonary blood flow - what are the advantages?
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In some situations the Glenn anastomosis is performed along with an additional source of antegrade pulmonary blood flow, either with
1.  an additional systemic to PA shunt
                         OR
 2. Banding main pulmonary artery (Pulsatile Glenn).

What are the advantages?
1. The pulmonary vascular bed is exposed to pulsatile pulmonary blood flow. According to certain studies exposing the pulmonary bed to this pulsatility improves growth of pulmonary vasculature pre-Fontan
2. Improved post operative SaO2. This effect may be negated in the long term where patients with only Glenn procedure may develop AP collaterals over time which causes their SaO2 to increase
3. The pulmonary vasculature is exposed to hepatic factor from the liver and therefore theoretically there is a lower likelihood of developing AP collaterals.

What are the disadvantages?
1. The Glenn pressure is elevated and the systemic venous pressure is raised. There may be longer post operative course with increase in chest tube drainage and delayed removal of chest tube. Increased incidence of chylothorax has also been noted in some studies.
2. The benefit of a Glenn by offloading the single ventricle is somewhat diminished.

There are purported benefits have been noted in several retrospective studies but no prospective trials have been performed till date to gauge the true advantage of this technique.

Good articles to refer to on pubmed include :
1. http://www.ncbi.nlm.nih.gov/pubmed/23321129
2. http://www.ncbi.nlm.nih.gov/pubmed/?term=Additional+Pulmonary+Blood+Flow+With+the+Bidirectional+Glenn+Anastomosis%3A+Does+It+Make+a+Difference%3F





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