Goal is to direct systemic venous return from upper 1/2 of body to pulmonary circulation, directly bypassing right heart
Originally described by Dr. William Glenn in 1958
End-to-end anastomosis of divided superior vena cava (SVC) to divided right pulmonary artery (PA)
SVC flow is directed to right lung only
Bidirectional Glenn shunt is more commonly used now
SVC is divided from right atrium at superior cavoatrial junction followed by end-to-side anastomosis between divided SVC & right PA
SVC flow is directed to both right & left PAs
Performed in patients with single ventricle physiology as staged palliative procedure prior to Fontan; final result is called total cavopulmonary connection
Glenn shunt forms stage 2 of Norwood procedure for hypoplastic left heart syndrome
By reducing volume load, bidirectional Glenn shunt reduces single ventricle wall stress & atrioventricular valve insufficiency
Since no synthetic graft material is used, shunt grows with child
Typically performed between 3-9 months of age
By this age, pulmonary vascular resistance has ↓ to level where systemic venous return enters pulmonary circulation without assistance of right heart pump
If 2 SVCs are present, each can be anastomosed to its respective PA, creating bilateral Glenn shunts
Azygous & hemiazygos veins are ligated as part of procedure
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Angiographic Findings
DIFFERENTIAL DIAGNOSIS
Selected References
Sethasathien S et al: Risk factors for morbidity and mortality after a bidirectional Glenn shunt in northern Thailand. Gen Thorac Cardiovasc Surg. 69(3):451-7, 2021
Khetan A et al: Asking bubbles for direction: assessment of a classic Glenn shunt using agitated saline contrast echocardiography. CASE (Phila). 4(6):485-9, 2020
Ma K et al: Effectiveness of bidirectional Glenn shunt placement for palliation in complex congenitally corrected transposed great arteries. Tex Heart Inst J. 47(1):15-22, 2020
Vermaut A et al: Outcome of the Glenn procedure as definitive palliation in single ventricle patients. Int J Cardiol. 303:30-5, 2020
Saleem K et al: Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot. Cardiol Young. 29(5):684-8, 2019
Hall EJ et al: Association of Shunt type with arrhythmias after Norwood procedure. Ann Thorac Surg. 105(2):629-36, 2018
Sharma R: The bidirectional Glenn shunt for univentricular hearts. Indian J Thorac Cardiovasc Surg. 34(4):453-6, 2018
Zahr RA et al: Half a century's experience with the superior cavopulmonary (classic Glenn) shunt. Ann Thorac Surg. 101(1):177-82, 2016
Kavarana MN et al: Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications. Expert Rev Cardiovasc Ther. 12(6):703-13, 2014
Alsoufi B et al: Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation. Eur J Cardiothorac Surg. 42(1):42-8; discussion 48-9, 2012
Dillman JR et al: Cardiovascular magnetic resonance imaging of hypoplastic left heart syndrome in children. Pediatr Radiol. 40(3):261-74; quiz 379-80, 2010
Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
Muthurangu V et al: Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome. Circulation 2005; Nov 22;112(21):3256-63, erratum in: Circulation. 113(5):e70, 2006
Bardo DM et al: Hypoplastic left heart syndrome. Radiographics. 21(3):705-17, 2001
Lamberti JJ et al: The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg. 100(1):22-9; discussion 29-30, 1990
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KEY FACTS
Terminology
Imaging
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TERMINOLOGY
Synonyms
Superior cavopulmonary shunt
Definitions
Goal is to direct systemic venous return from upper 1/2 of body to pulmonary circulation, directly bypassing right heart
Originally described by Dr. William Glenn in 1958
End-to-end anastomosis of divided superior vena cava (SVC) to divided right pulmonary artery (PA)
SVC flow is directed to right lung only
Bidirectional Glenn shunt is more commonly used now
SVC is divided from right atrium at superior cavoatrial junction followed by end-to-side anastomosis between divided SVC & right PA
SVC flow is directed to both right & left PAs
Performed in patients with single ventricle physiology as staged palliative procedure prior to Fontan; final result is called total cavopulmonary connection
Glenn shunt forms stage 2 of Norwood procedure for hypoplastic left heart syndrome
By reducing volume load, bidirectional Glenn shunt reduces single ventricle wall stress & atrioventricular valve insufficiency
Since no synthetic graft material is used, shunt grows with child
Typically performed between 3-9 months of age
By this age, pulmonary vascular resistance has ↓ to level where systemic venous return enters pulmonary circulation without assistance of right heart pump
If 2 SVCs are present, each can be anastomosed to its respective PA, creating bilateral Glenn shunts
Azygous & hemiazygos veins are ligated as part of procedure
IMAGING
General Features
CT Findings
MR Findings
Ultrasonographic Findings
Angiographic Findings
DIFFERENTIAL DIAGNOSIS
Selected References
Sethasathien S et al: Risk factors for morbidity and mortality after a bidirectional Glenn shunt in northern Thailand. Gen Thorac Cardiovasc Surg. 69(3):451-7, 2021
Khetan A et al: Asking bubbles for direction: assessment of a classic Glenn shunt using agitated saline contrast echocardiography. CASE (Phila). 4(6):485-9, 2020
Ma K et al: Effectiveness of bidirectional Glenn shunt placement for palliation in complex congenitally corrected transposed great arteries. Tex Heart Inst J. 47(1):15-22, 2020
Vermaut A et al: Outcome of the Glenn procedure as definitive palliation in single ventricle patients. Int J Cardiol. 303:30-5, 2020
Saleem K et al: Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot. Cardiol Young. 29(5):684-8, 2019
Hall EJ et al: Association of Shunt type with arrhythmias after Norwood procedure. Ann Thorac Surg. 105(2):629-36, 2018
Sharma R: The bidirectional Glenn shunt for univentricular hearts. Indian J Thorac Cardiovasc Surg. 34(4):453-6, 2018
Zahr RA et al: Half a century's experience with the superior cavopulmonary (classic Glenn) shunt. Ann Thorac Surg. 101(1):177-82, 2016
Kavarana MN et al: Pulmonary arteriovenous malformations after the superior cavopulmonary shunt: mechanisms and clinical implications. Expert Rev Cardiovasc Ther. 12(6):703-13, 2014
Alsoufi B et al: Current outcomes of the Glenn bidirectional cavopulmonary connection for single ventricle palliation. Eur J Cardiothorac Surg. 42(1):42-8; discussion 48-9, 2012
Dillman JR et al: Cardiovascular magnetic resonance imaging of hypoplastic left heart syndrome in children. Pediatr Radiol. 40(3):261-74; quiz 379-80, 2010
Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
Muthurangu V et al: Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome. Circulation 2005; Nov 22;112(21):3256-63, erratum in: Circulation. 113(5):e70, 2006
Bardo DM et al: Hypoplastic left heart syndrome. Radiographics. 21(3):705-17, 2001
Lamberti JJ et al: The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg. 100(1):22-9; discussion 29-30, 1990
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