A Case Report of Bidirectional Glenn Shunt as a Therapeutic Aid in an Urgent Operation for Active Tricuspid Valve Endocarditis / 日本心臓血管外科学会雑誌

ABSTRACT

We had the opportunity to use a bidirectional Glenn shunt (BDG) as a therapeutic aid in an urgent operation of active tricuspid valve endocarditis in an adult case with the tetralogy of Fallot. The patient was a 44-year-old man with untreated tetralogy of Fallot. He noticed progressing dyspnea on exertion and chest discomfort a few years previously. He had suffered from fever and cough during these several months. At last he was admitted to our Center on an emergency basis due to persistent high fever. Echocardiography revealed large vegetation on the tricuspid valve along with positive blood culture of <i>Streptococcus</i>. Antibiotic therapy was started, but septic lung embolism forced us to perform an urgent operation. To avoid using an artificial valve or leaving free tricuspid regurgitation with tricuspid valve excision, we repaired the tricuspid valve using fresh autologous pericardium and DeVega annuloplasty. Since we left stenosis at tricuspid valve, we added the BDG to minimize the volume load on the repaired tricuspid valve. It worked well and the patient successfully was weaned from CPB. Despite the initial postoperative course related to the lung abscess from the infected embolism, the patient is doing well at home 12 months after the surgery. This strategy using BDG is one modalilty to cope with this formidable situation.