Introduction

The Glenn procedure, also known as the Glenn shunt procedure or bidirectional Glenn (BD Glenn) procedure, is a crucial surgical intervention used to manage complex congenital heart defects in children—particularly those affecting the right side of the heart, such as single ventricle defects. It serves as the second stage of a three-step surgery (following the Norwood procedure and before the Fontan procedure) often performed in early childhood, typically between 4 to 6 months of age.

This operation plays a vital role in rerouting blood circulation in patients whose hearts cannot effectively pump oxygen-poor blood to the lungs. In a BD Glenn procedure, the superior vena cava (SVC)—a large vein that carries deoxygenated blood from the upper body—is connected directly to the pulmonary arteries, bypassing the heart. This allows blood to flow passively into the lungs for oxygenation, significantly reducing the workload on the heart and improving oxygen levels in the bloodstream.

The bidirectional Glenn procedure is particularly effective for children with:

Tricuspid atresia

Hypoplastic left or right heart syndrome

Pulmonary atresia

Other complex congenital heart anomalies involving underdeveloped or malformed ventricles

Over the years, the Glenn shunt procedure has shown excellent long-term survival outcomes when performed by experienced pediatric cardiac surgeons at specialized centers. It also prepares the child’s body for the next surgical stage (Fontan procedure) to optimize overall circulation in single-ventricle physiology.

At Innayat Medical, we work closely with some of the best pediatric cardiology teams in India to offer affordable and high-quality Glenn procedures for children from around the world.

More Information About the Glenn Procedure in Pediatric Cardiology

The Glenn procedure—more specifically, the bidirectional Glenn (BD Glenn) procedure—is a highly specialized surgery that plays a critical role in the staged treatment plan for children born with single-ventricle heart defects. Understanding how and why this procedure is performed can give parents greater confidence in the path ahead.

What Is the Glenn Shunt Procedure?
The Glenn shunt procedure is a type of heart surgery where the superior vena cava (SVC)—a large vein that carries oxygen-poor blood from the upper body—is surgically connected directly to the pulmonary arteries. This allows blood to bypass the right side of the heart and flow passively into the lungs for oxygenation. By doing this, the heart’s workload is reduced, and oxygen delivery throughout the body is improved.

This surgery is called “bidirectional” because blood from the SVC is allowed to flow into both the left and right pulmonary arteries.

Who Needs the BD Glenn Procedure?
Children born with complex congenital heart defects involving underdeveloped or malformed ventricles often require a BD Glenn procedure. These conditions include:

Hypoplastic Left Heart Syndrome (HLHS)

Tricuspid Atresia

Double-Inlet Left Ventricle (DILV)

Pulmonary Atresia

Single Ventricle Defects

Heterotaxy Syndrome

The Glenn is typically the second stage of a three-part surgery:-

Stage 1: Norwood Procedure (done shortly after birth)

Stage 2: Bidirectional Glenn Procedure (at around 4–6 months of age)

Stage 3: Fontan Procedure (usually between 2–4 years of age)

How Is the Glenn Procedure Performed?

• Anesthesia: The child is placed under general anesthesia.
• Surgical Access: A median sternotomy (incision through the breastbone) is made.
• Heart-Lung Bypass: A machine temporarily takes over heart and lung function.
• Shunt Creation: The surgeon disconnects the SVC from the heart and connects it to the right pulmonary artery. This creates a direct path for blood to flow into the lungs.
• Closure and Recovery: The chest is closed, and the child is monitored in the Pediatric ICU (PICU).

The Glenn procedure usually takes about 4–6 hours. Recovery in the hospital typically lasts 7–14 days, depending on the child’s condition and response to surgery.

Why the Bidirectional Glenn Procedure Is Critical
This surgery helps prepare the child’s body for the Fontan procedure, which completes the circulation system without relying on two working ventricles. Without the Glenn shunt procedure, children with single ventricle defects would struggle with chronic low oxygen levels and heart failure symptoms.

Recovery & Follow-Up

• Most children spend 2–3 days in the Pediatric ICU
• They are usually discharged within 10–14 days
• Regular follow-up with a pediatric cardiologist is necessary
• Medications may be prescribed to support heart function and prevent clotting
• Long-term, children who undergo the BD Glenn procedure often lead active lives with careful monitoring and timely intervention for any complications.