Percutaneous salvage interventions in the Glenn circuit: a case series

Abstract

Background In majority of children bidirectional Glenn shunt is a safe and efficacious procedure with minimal post-operative issues. Rarely, there may be dysfunction in the Glenn pathway due loss of anatomical integrity or derangements in normal physiological or hemodynamic milieu. We report 4 cases in the last 3 years (2016-2019) where complications in the Glenn circuit led to serious consequences requiring transcatheter interventions. Case presentation Two of our patients presented with frank features of superior vena cava syndrome. One of them had right Glenn anastomotic site narrowing leading to severe obstruction along with significant left pulmonary artery origin stenosis. The other child had excessive antegrade flow impeding normal Glenn flow leading to superior vena cava syndrome. The next child in our series was initially lost to follow-up after bidirectional Glenn surgery. Later on, this child was noted to have discontinuous left pulmonary artery with perfusion only to the right lung from the Glenn. The remaining child described in this series had developed a large tortuous venous collateral post Glenn shunt leading to severe cyanosis. All the above children needed prompt percutaneous interventions to revert back to their basal state. On follow-up, the benefit was sustained in all. Conclusions Percutaneous intervention procedures often provide a successful bailout option in various complicated situations post Glenn surgery with reasonable efficacy and safety.

Late Presentation of D-TGA Complicated by Functional Glenn Shunt Obstruction Led to SVC Syndrome 10 Years Later: a Rare Case Report

“…However, reports have been made of this syndrome as a consequence of antegrade ow-mediated Glenn failure, also referred to as functional obstruction. SVC syndrome due to a functional obstruction is diagnosed through cardiac catheterization and resolved by a procedure that allows a fall in the PA pressure [12]. As a complication of the SVC syndrome, our patient developed 'downhill' esophageal varices which led to an upper gastrointestinal bleeding managed by ligation.…”

“…Commonly, patients with Glenn procedure have complications regarding the venous redistribution and development of pulmonary MAVs and some patients can present with pleural effusion as the case presented [11]. Additionally, SVC syndrome has been reported in some cases due to thrombosis of the SVC [12].…”