Contribuição para o diagnóstico e o tratamento das fístulas arteriovenosas pulmonares após a operação de Glenn bidirecional

Abstract

ObjectiveTo determine the incidence of pulmonary arteriovenous fistulae (PAVFs) after the bidirectional Glenn operation and the possible independent variables that could influence their appearance; to confirm the use of microbubble contrast echocardiography for the detection of PAVFs; and to test the sensitivity and specificity of pulmonary angiography. MethodsFrom March 1990 to December 1995 patients were operated upon. Their ages ranged from 2 to 132 months (mean, 32.7± 33.6 Conclusion The incidence of PAVFs after the bidirectional Glenn operation was high (37%). The time interval elapsed after the bidirectional Keywords pulmonary arteriovenous fistulae, bidirectional Glenn operation, microbubble contrast echocardiographyCyanogen congenital heart diseases, which behave functionally as univentricular heart, are usually characterized by a poor prognosis, unsatisfactory quality of life, and impossibility of surgical correction that reestablishes the normal cardiac anatomy.In the past 4 decades, several proposals for palliative operations have been tested, initially in experimental animals, and then, if successful, in children with such defects. One of them, the Glenn operation, was based on the principle that systemic venous blood might reach the pulmonary circulation without the participation of the right cardiac cavities. This operation was experimentally proposed by Carlon et al 1 in 1951, successfully performed for the first time by Meshalkin 2 and Bakulev 3 in 1956, and diffused by Glenn 4 in 1958. The classical Glenn operation, as this procedure has been known, remained unaltered for many years. Haller et al 5 experimentally introduced the concept of bilateral partial cavopulmonary anastomosis, in which the continuity between the pulmonary arteries was preserved by a terminolateral anastomosis between the superior vena cava and the right pulmonary artery.Azzolina et al 6 performed that operation for the first time, which became known as the bidirectional Glenn operation. The major advantage of this technique was that the right pulmonary artery, not separated from the confluence, allowed the division of the blood volume of the superior vena cava between both lungs.Mathur and Glenn 7 reported the late evolution of 56 patients out of 63 who underwent the classical Glenn operation and described for the first time the development of pulmonary arteriovenous fistulae in that type of operation. From this publication onwards, other studies reported such complications 8,9 , decreasing the enthusiasm in regard to the classical Glenn operation, which was then abandoned in favor of the bidirectional Glenn operation 6,10 . MethodsFrom March 1990 to December 1995, 59 patients with complex cyanogen congenital heart diseases underwent the bidirectional Glenn operation at our service. Five patients died, 4 immediately after the procedure and one during hospitalization. The 54 survivors comprised the case series of this study. Age, on the occasion of the operation, varied from 2 to 132 (mean, 31.4±33.56; median, 18.5) mont...

Cavopulmonar total com tubo extracardíaco sem circulação extracorpórea

“…After all the procedures described above, the anastomosis was completed and the clamps were removed. The final aspect of the superior vena cava anastomosed directly to the RPA is called superior bidirectional cavopulmonary anastomosis or bidirectional Glenn anastomosis [1,2].…”