Steps of surgery:
The patient was taken up for a first stage bidirectional Glenn shunt.
The chest was opened with a midline sternotomy. Both lobes of the thymus
were excised. Cardiopulmonary bypass was established with aorta –
innominate vein – right atrial cannulation. The ductus was transfixed
with 2 sutures after division.
The MPA was then transected. The cardiac end was sutured off in 2
layers. MPA continued as RPA. The pulmonary end of MPA was dissected,
mobilized fully and then separated from the aorta along its entire axis.
The LPA was transected beyond the origin at its mid portion and an
incision was made into the pulmonary end of the LPA extending upto the
hilum so as to create wide mouth of opening. (Figures 1B, 1C) Thereafter
the pulmonary end of MPA was turned down alongside the opened LPA and
both stomas were anastomosed to each other with 6/0 continuous prolene
sutures (Figure 1D, Figure 3).
Thereafter the bidirectional Glenn shunt was performed in standard
fashion. She made an uneventful recovery with resting saturations on
room air climbing to 85%. The LPA anatomy and the confluence were
evaluated after 6 months using a CT angiogram and was found to be
satisfactory (Figure 2B). She is awaiting rapid Fontan completion in
view of her age.