LAUSR

BACKGROUND An additional shunt in single ventricle patients with Glenn anastomosis may increase pulmonary flow at the expense of ventricle volume overloading. The performance of the modification depends on pulmonary resistance, indicating better results in favorable hemodynamic conditions. AIM Analyze the influence of precisely adjusted, pulsatile shunt in borderline, high-risk Glenn patients on the early and late results. METHODS The study involved 99 patients, 21 children with the bidirectional Glenn and accessory pulsatile shunt (BDG&S group), and 78 patients with the classic bidirectional Glenn anastomosis (BDG group). RESULTS There was one death in the BDG&S group and four deaths in the BDG group. No difference in mortality (P = 0.71) was found. The Fontan completion was achieved in 69 children (88.5%) in the BDG group and 18 patients (85.7%) in the BDG&S group, without mortality. No difference in postoperative pulmonary artery pressure (P = 0.10), ventilation time (P = 0.12), McGoon ratio (P = 0.9), or chylothorax frequency (P = 0.14) was found. ICU (P = 0.28) and hospitalization (P = 0.05) times were comparable. The echocardiography revealed no significant differences in the ventricle and atrioventricular valve function between groups. In the BDG&S group, higher blood oxygen saturation (P = 0.03) and (P = 0.002) increase of the McGoon index were noted.    Conclusions: BDG  with precise adjusted accessory pulmonary blood flow provides stable hemodynamics and adequate oxygen saturation in borderline, profoundly hypoxic patients. An advantageous pulmonary artery development before Fontan completion was observed.