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Background: The in foreign famous heart center, bi-directional Glenn shunt (bidirectional Glenn shunt, BDG) is considered a low-risk surgical technique is generally used in severe cyanotic congenital heart disease. However, in developing countries, the procedure is applied later, the total number of operations and other areas of research and exploration and advanced center there are still obvious gap; system of the clinical application of surgical and postoperative follow-up study reported not many. Objective: This retrospective study analyzed 57 cases of the center in recent years carried out bidirectional Glenn shunt, designed to further clarify the indications of the bidirectional Glenn shunt; evaluation of the surgery on children with oxygen to promote the development of pulmonary vascular improve heart function and other aspects the exact effect; explore improving the efficacy and reduce the impact factors of postoperative complications. Methods: From August 2000-December 2007 a total of 57 patients with complex cyanotic congenital heart disease in my center received a bidirectional Glenn shunt surgery, including the SV 22 cases, TA 19, PA / IVS associated with TS Hypoplastic RV cases, PA / VSD with Hypoplastic RV or L-TGA, SI of five cases, D-TGA with Unbalanced AVSD, PS 2 Li, DORV with PS 6. 35 cases were male and 22 female; average age: 32.52 ± 40.21 m (of 3 ~~ 186 m); an average body weight of 10.37 ± 6.34 kg (5.0 to 32.5 kg); 11 The children were due to concomitant left superior vena cava underwent bilateral cavopulmonary anastomosis. The children surgery combined anesthesia cardiopulmonary bypass, and received regular follow-up effective after care support and outside the hospital. Surgery before and after monitoring the SpO 2 , Hct, Hb changes, compare pulmonary artery and Nakata, McGoon index value, the follow-up echocardiographic indicators EDVI ESWS, PSWS, PWT, EF and Vcf the change, explore the surgical procedure and perioperative management measures. Results: The mean postoperative mechanical ventilation time: 25.04 ± 21.13h (4h ~ 186h, median 24h); average residence time care unit: 3.62 ± 4.73d (0.8 ~~ 11d, median number 4d); average length of stay: 11.33 ± 5.78d (6 ~~ 28 days, the median 9d). Were no operative mortality, early complications: pleural effusion, heart failure, chest bleeding, respiratory insufficiency, chylothorax, atelectasis, etc.. Discharge, SpO , 2 from preoperative average 75.26 ± 7.54% to on Postoperative 89.74 ± 6.21% (P lt; 0.01), and lt; year-old cases of group SpO 2 improvement is better than ≥ 3-year-old group (90.81 ± 4.53% vs 87.39 ± 5.37%, P lt; 0.05). Effective follow-up 55 patients, up from 3 months to 5 years in August, unexplained hospital and 1 died, completed Phase II TCPC 19 cases, the remaining survival cases are still under follow-up observation, waiting for the timing of the Phase II surgery. During, SpO , 2 was further reduced to an average of 85.62 ± 7.41% (P lt; 0.01); the Hct preoperative average 54.24 ± 10.61% to 49. 72 ± 11.28% (P lt; 0.05); Hb from preoperative average of 203.51 ± 28.17 g / L fell to 171.34 ± 26.77g / L (P lt; 0.05); The the Nakata index by preoperative average 146.97 ± 28.51 mm 2 / m 2 rose 189.26 ± 34.09 mm 2 / m 2 (P lt; 0.05, n = 46); McGoon index by the preoperative average rose to 1.53 ± 0.47, 1.21 ± 0.31 (P lt ; 0.05, n = 46). Follow-up echocardiographic indicators the EDVI, ESWS and PSWS compared with preoperative significantly decreased, PWT, EF and Vcf compared with preoperative increased significantly (both P lt; 0.05). 2 patients follow-up found anatomical problems were cavopulmonary anastomosis mild stenosis and mild stenosis of the superior vena cava, are in Phase Ⅱ surgical correction of together. Conclusion: the bidirectional Glenn shunt for complex cyanotic congenital heart disease in children is a good palliative surgery, the postoperative increase pulmonary blood flow, improve whole body oxygen saturation, improve cyanosis, improve quality of life, and can effectively improve heart function promote the development of pulmonary vascular surgery for two conditions; reasonable indications for surgery, the appropriate surgical approach, the correct perioperative period of treatment, after appropriate to shorten the operation time of the Phase Ⅱ made good surgical results and reduce intraoperative after complications.
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