While the classical 1-stage Norwood procedure is still performed, there are several
types of “hybrid” procedures for the management of hypoplastic left heart syndrome.
These hybrid approaches consist of bilateral pulmonary artery banding with ductal
stenting or prostaglandin infusion as the first-stage palliation, followed by a second-stage
Norwood procedure or comprehensive stage II procedure. Since 2012, we have adopted
a rapid 2-stage Norwood procedure as a routine strategy, where bilateral pulmonary
artery banding is performed within 5 days of age with balloon atrial septectomy, if
needed, before the development of hemodynamic instability. The second-stage Norwood
procedure is performed within 1 month of age. The arterial duct is kept open by continuing
prostaglandin administration. In addition, an important improvement of our Norwood
procedure is the use of an auto-pericardial patch fixed on an arch-shaped metal mold.
The pericardium is wrapped around the lesser curvature of the mold and treated with
0.6% glutaraldehyde for 15 min. This makes it easier to imagine the final shape of
the arch and helps to enlarge the retroaortic space significantly, which could reduce
the risk of bronchus or central pulmonary artery stenosis and facilitate hemostasis.
These developments in strategy and procedure could improve our surgical results.
Keywords
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Article info
Publication history
Published online: April 18, 2022
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In Press Journal Pre-ProofFootnotes
Conflict of Interest: The authors do not have any conflicts to disclose with regard to commercial support.
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