نقدم هنا طريقة مبسطة لإجراء عملية غلين ذات الاتجاهين (عملية المسرب
Bidirectional Glenn’s Cavo-Pulmonary Shunt - ـ الاتجاه ثنائية الرئوي الأجوفي
BDG (لا نستعمل فيها جهاز الدوران الاصطناعي كما نستغني عن المسرب المؤقت الذي
يلجأ إليه أحياناً للاعتقاد بأنه يخفف من الاحتقان الوريدي في القسم العلوي من الجسم في
أثناء العمل الجراحي. تنطلق طريقتنا من الفكرة القائلة: إن الاحتقان الوريدي الحاد الناجم
عن وضع ملقط وعائي ساد على الأجوف العلوي في أثناء العمل الجراحي يجد له منفساً
عبر المفاغرات الوريدية التشريحية الغزيرة بين منظومة الأجوف العلوي و منظومة الأجوف
السفلي، و من فكرة أن دماغ المرضى ذوي الإشباع المنخفض في أكسيجين الدم الشرياني
يتحمل نقص الأكسجة المؤقت (الذي قد يحصل من جراء نقص الجريان الدموي العابر
و الناجم بدوره عن الاحتقان الوريدي المؤقت في أثناء زمن تطبيق الملقط الوعائي على
الأجوف العلوي) بشكل أفضل من دماغ الإنسان الطبيعي.
We present here a simplified method to perform Bidirectional
Glenn’s Cavo-Pulmonary Shunt (BDG) in which we use no
cardiopulmonary bypass (CPB) nor an intra-operative temporary shunt,
sometimes used on the belief that it lessens the developed intra-venous
congestion and pressure in the upper torso, intra-operatively. Our approach
springs from the idea that acute intra-venous congestion, resulting from the
application of vascular cross-clamp on the superior vena cava (SVC) during
operation, is being vented through abundant and numerous anatomic
venous anastomoses between the SVC system and the inferior vena cava
(IVC) system. It also springs from the conception that the brain of patients
with low arterial blood O2-saturation tolerates cerebral hypoxia better than
the normally functioning brain. Such hypoxia may ensue from the transient
low cerebral arterial blood flow, resulting in turn from the temporary intravenous
cerebral congestion (and related raised pressure) following SVC
clamping.
References used
Gleen WWL. Circulatory bypass of the right side of the heart IV: shunt between superior venacava and distal right pulmonary artery: report of the clinical application. N Engl J Med 1958; 259: 117-132
Lamberti JJ, Spicer RL, Waldaman JD, et al. The bidirectional cardiopulmonary shunt. J Thorac Cardiovasc Surg 1990; 100: 22-30
Lal M, Mahant TS. A modified Technique of Venoatrial bypass in bidirectional Glenn shunt. Asian Cardiovasc Thorac Ann 1996; 4: 23-5
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