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Pediatrics
Diagnosis
Cardiac
Surgical Procedures for Congenital Heart Disease
Glenn Shunt
Glenn Shunt
Randy R. Richardson, MD; Prakash M. Masand, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        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

                    1. 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
                    2. 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
                    3. 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
                    4. Vermaut A et al: Outcome of the Glenn procedure as definitive palliation in single ventricle patients. Int J Cardiol. 303:30-5, 2020
                    5. Saleem K et al: Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot. Cardiol Young. 29(5):684-8, 2019
                    6. Hall EJ et al: Association of Shunt type with arrhythmias after Norwood procedure. Ann Thorac Surg. 105(2):629-36, 2018
                    7. Sharma R: The bidirectional Glenn shunt for univentricular hearts. Indian J Thorac Cardiovasc Surg. 34(4):453-6, 2018
                    8. Zahr RA et al: Half a century's experience with the superior cavopulmonary (classic Glenn) shunt. Ann Thorac Surg. 101(1):177-82, 2016
                    9. 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
                    10. 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
                    11. 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
                    12. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                    13. 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
                    14. Bardo DM et al: Hypoplastic left heart syndrome. Radiographics. 21(3):705-17, 2001
                    15. Lamberti JJ et al: The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg. 100(1):22-9; discussion 29-30, 1990
                    Related Anatomy
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                    Related Differential Diagnoses
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                    References
                    Tables

                    Tables

                    KEY FACTS

                    • Terminology

                      • Imaging

                        • Top Differential Diagnoses

                          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

                                      1. 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
                                      2. 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
                                      3. 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
                                      4. Vermaut A et al: Outcome of the Glenn procedure as definitive palliation in single ventricle patients. Int J Cardiol. 303:30-5, 2020
                                      5. Saleem K et al: Bidirectional Glenn for residual outflow obstruction in Tetralogy of Fallot. Cardiol Young. 29(5):684-8, 2019
                                      6. Hall EJ et al: Association of Shunt type with arrhythmias after Norwood procedure. Ann Thorac Surg. 105(2):629-36, 2018
                                      7. Sharma R: The bidirectional Glenn shunt for univentricular hearts. Indian J Thorac Cardiovasc Surg. 34(4):453-6, 2018
                                      8. Zahr RA et al: Half a century's experience with the superior cavopulmonary (classic Glenn) shunt. Ann Thorac Surg. 101(1):177-82, 2016
                                      9. 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
                                      10. 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
                                      11. 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
                                      12. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                                      13. 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
                                      14. Bardo DM et al: Hypoplastic left heart syndrome. Radiographics. 21(3):705-17, 2001
                                      15. Lamberti JJ et al: The bidirectional cavopulmonary shunt. J Thorac Cardiovasc Surg. 100(1):22-9; discussion 29-30, 1990