Palliative surgeries and their classification.. Glenn's surgery. Partial cavopulmonary anastomosis. Fontan-Kreutzer surgery. Total cavo-pulmonary anastomosis. Hybrid procedure

Palliative surgeries and their classification:

1- Glenn's surgery:

Partial cavopulmonary anastomosis (upper).
This surgery is performed in patients who have a single functional ventricle, either right or left morphology.

It consists of detaching the superior vena cava from the right atrium and attaching it directly to the pulmonary artery to carry deoxygenated (blue) blood directly to the lung.

This surgery must be performed between the 5th and 6th month of life and ideally with more than 5 kilos of weight.

The figure shows a Hypoplastic Left Heart Syndrome with Norwood Surgery in the Second Stage (Glenn Surgery).
At this time, the Sano Tube or the Blalock Taussing Fistula have been dismantled.

2- Fontan-Kreutzer surgery:

Total cavo-pulmonary anastomosis.
In this surgery, the inferior vena cava, which carries deoxygenated (blue) blood from the lower half of the body to the right atrium, is removed and anastomosed directly into the pulmonary artery.

As there is a significant distance between these two structures, it is not possible to join them directly, as is done in Glenn's surgery with the superior vena cava.

Therefore, an extracardiac tube made of a special material must be interposed, in this way the surgical management of patients with a single ventricle is completed, leaving the heart to pump only the oxygenated (red) blood that comes from the lungs and thus prolonging its proper functioning.

3- Hybrid procedure:

It is the one that unites the techniques and skills of pediatric interventional cardiologists (hemodynamics) with those of pediatric cardiovascular surgeons.

This procedure is performed to provide a temporary solution in very complex heart disease.

The procedure for the case of Hypoplastic Left Heart Syndrome (HLHS) consists of a surgery where after opening the chest in the conventional way as would be done for any other type of cardiovascular procedure, the surgeon performs a cerclage in each of the branches lungs, to limit the excess blood flow that passes to the lungs and the hemodynamicist implants a mesh of synthetic material called a stent in the ductus arteriosus in order to prevent it from closing and maintain the passage of blood flow towards the systemic circulation.