الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
T
he bidirectional Glenn operation was introduced clinically by Azzolina in 1972 and is well established palliative procedure for single ventricular heart. At present, bidirectional Glenn shunt is typically performed as one step of the staging procedure in preparation for a Fontan procedure or as a long-term palliation for high-risk Fontan candidate.
Moreover, registries of patients with bidirectional Glenn shunt have been instrumental in characterizing the presentation, quality of life and complications during follow ups. Establishing a first of a kind registry in Egypt will provide us a unique data tailored to our country.
Our registry included 178 patients who underwent bidirectional Glenn procedure referred for follow up in Ain Shams university hospital from January 2019 till July 2020.
The mean age of the registry was 18.7 ± 8.26 (range between 5 and 37 years), 85 males (48%) and 93 Females (52%). Regarding the basic anatomy, double outlet right ventricle was the commonest.
Furthermore, our descriptive study confirmed many characteristic similarities between our patients and patients in developing countries. Our patients underwent bidirectional Glenn shunt at a median age of 6 years which is considered a relatively old age but similar to others studies that have been made in developing countries like Pakistan, India and Iran. There is a significant delay in the operation in Egyptians patients due to lack of patients awareness, few number of primary health care facilities and high economic burden.
In our study, we have evaluated veno-venous collaterals in patients with bidirectional Glenn shunt. There was statistically significant difference between patients with and without veno-venous collateral presence detected by catheterization regarding the degree of desaturation evaluated during the six-minutes-walk test proving that these collaterals are a leading cause of morbidity causing significant desaturation especially during exercise.
In our registry, we have determined the RDW as a predictor of oxygen saturation and showed a RDW cutoff value of 21.8% had the highest balanced sensitivity (53.85%) and specificity (69.91%) to determine oxygen saturation less than 80% on room air.
In addition, we determined another predictors for functional capacity including hemoglobin level and MCHC. A hemoglobin level cutoff value of 19.3 g/dl and a MCHC cutoff value of 30.9 g/dl provided the highest balanced sensitivity and specificity to distance walked during the six-minutes-walk test less than 300 m.
To conclude, the development of a clinical registry of post bidirectional Glenn shunt patients in a tertiary center in a developing country will result in improvement in the public health and better health service for those selected population and will help us to provide them a better quality of life and avoid associated cardiac morbidity and mortality.