{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T08:53:45Z","timestamp":1767084825716},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"5","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["www.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2019,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S1047951119000866_as1\"><jats:title>Background:<\/jats:title><jats:p>Residual right ventricular outflow obstruction during Tetralogy of Fallot repair necessitates peri-operative revision often requiring trans-annular patch with its negative sequels. Bidirectional Glenn shunt in this setting reduces trans-pulmonary gradient to avoid revision.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951119000866_as2\"><jats:title>Methods:<\/jats:title><jats:p>Bidirectional Glenn shunt was added during Tetralogy repair in patients with significant residual obstruction. A total of 53 patients between January, 2011 and June, 2018 were included. Final follow-up was conducted in July, 2018.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951119000866_as3\"><jats:title>Results:<\/jats:title><jats:p>Mean age at operation was 5.63\u00b13.1 years. Right to left ventricular pressure ratio reduced significantly (0.91\u00b10.09 versus 0.68\u00b10.05; p&lt;0.001) after bidirectional Glenn, avoiding revision in all cases. Glenn pressures at ICU admission decreased significantly by the time of ICU discharge (16.7\u00b13.02 versus 13.5\u00b12.19; p&lt;0.001). Pleural drainage \u2265 7 days was seen in 14 (26.4%) patients. No side effects related to bidirectional Glenn-like facial swelling or veno-venous collaterals were noted. Mortality was 3.7%. Discharge echocardiography showed a mean trans-pulmonary gradient of 32.11\u00b15.62 mmHg that decreased significantly to 25.64\u00b15 (p&lt;0.001) at the time of follow-up. Pulmonary insufficiency was none to mild in 45 (88.2%) and moderate in 6 (11.8%). Mean follow-up was 36.12\u00b125.15 months (range 0.5\u201390). There was no interim intervention or death. At follow-up, all the patients were in NYHA functional class 1 with no increase in severity of pulmonary insufficiency.<\/jats:p><\/jats:sec><jats:sec id=\"S1047951119000866_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>Supplementary bidirectional Glenn shunt significantly reduced residual right ventricular outflow obstruction during Tetralogy of Fallot repair avoiding revision with satisfactory early and mid-term results.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s1047951119000866","type":"journal-article","created":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T03:35:16Z","timestamp":1558582516000},"page":"684-688","update-policy":"http:\/\/dx.doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Bidirectional Glenn for residual outflow obstruction in Tetralogy of 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