Norwood procedure to hypoplastic left heart syndrome

Abstract

Since March 1992, 25 neonates and small infants with HLHS have undergone a modified Norwood procedure. The mean age and weight at operation were 17 days (2 days-2 months) and 2.7 kg (1.6-3.3 kg). Isolated cerebral and/or myocardial perfusion (ICMP) with direct anastomosis of aorta and pulmonary artery was utilized since January 1995 to 16 patients. Under median sternotomy, PTFE graft (usually 3.0-3.5 mm) was anastomosed to the brachiocephalic artery and the arterial cannula was inserted to this PTFE graft. The left carotid and the left subclavian arteries were snared and a clamp was placed on the aortic arch just distal to the brachiocephalic artery. This allowed blood to enter the brain and the coronary arteries, keeping the brain perfused and the heart-beating. After reconstruction of distal aortic arch, a single dose of crystalloid cardioplesia was infused and the rest of the arch was reconstructed. There were 14 early deaths (56%) and 4 late deaths (16%). Bidirectional Glenn procedure was performed to 5 patients with 1 death. Three patients underwent modified Fontan procedure without mortality. Mean aortic cross clamp time was 24 min. and mean ICMP time was 32 min. There was no neurologic complications. In conclusion, isolated cerebral and/or myocardial perfusion may offer an advantage of protecting the brain and myocardium during arch in Norwood procedure.

Femoral vein homograft as Sano shunt results in improved pulmonary artery growth after Norwood operation

“…The procedure for the Norwood-Sano operation has been well described previously. 2,13,14 Essentially, an identical approach was used in both institutions. The surgery was performed with the use of cardiopulmonary bypass under conditions of deep hypothermia.…”

“…The procedure for the Norwood–Sano operation has been well described previously 2 13 , 14 Essentially, an identical approach was used in both institutions.…”

“…1 A regulated source of pulmonary blood flow is achieved either with a modified Blalock-Taussig shuntthat is, Norwood-Blalock-Taussig 1or with the Sano modification using a right ventricle to pulmonary artery shunt: that is, Norwood-Sano. 2,3 The Norwood-Blalock-Taussig is associated with diastolic "coronary steal" and decreased myocardial perfusion of the systemic single ventricle. This may result in postoperative haemodynamic instability and interstage mortality.…”

Nova técnica: operação de Norwood com perfusão regional cerebral e coronariana

“…Poirier et al [22] modified the reconstruction of the neoaorta and proposed high-flow CPB using phenoxybenzamine to reduce systemic vascular resistance. Another change that resulted in higher stability of the patient in the postoperative period was the anastomosis of the PTFE tube between the right ventricle and the pulmonary arteries or Sano's operation [23]. According to Silva et al [24], there were no significant difference in mortality in the Norwood operation when Blalock-Taussig shunt and Sano's operation are performed, but there was significant improvement in survival in the second stage when the bidirectional Glenn procedure was performed in the Sano's operation group.…”

Simplified Antegrade Cerebral Perfusion and Myocardial Protection during Stage I Norwood Procedure

“…1,3,4 In these reports, cannulation of the innominate artery was typically performed through a PTFE graft, sutured in an end-to-side fashion to the vessel. Perfusion to the descending aorta was provided by a second arterial cannula inserted through the pericardium, just above the left hemi-diaphragm.…”