ABSTRACT
This article will detail Dr. James Tweddell's operative technique and considerations for 26 all three stages of SVP in patients with HLHS. This will include the Norwood Procedure with 27 Right-Ventricle-to-Pulmonary-Artery Conduit (Sano Modification), Bidirectional Glenn 28 (Superior Cavopulmonary Connection), and Extracardiac, Fenestrated Fontan Completion (Total 29 Cavopulmonary Connection). These techniques are the culmination of over 20 years of experience 30 and represent the final techniques he employed at both Children's Hospital of Wisconsin and 31 Cincinnati Children's Hospital Medical Center.
Subject(s)
Fontan Procedure , Hypoplastic Left Heart Syndrome , Norwood Procedures , Palliative Care , Hypoplastic Left Heart Syndrome/surgery , Hypoplastic Left Heart Syndrome/history , Humans , Fontan Procedure/history , Fontan Procedure/methods , Norwood Procedures/history , History, 20th Century , Treatment Outcome , History, 21st Century , Heart Ventricles/surgery , Heart Ventricles/abnormalitiesABSTRACT
Over the last quarter of a century, improvements in antenatal diagnosis, preoperative care, neonatal surgical techniques, arch reconstruction, cardiopulmonary bypass strategies, catheter-based interventions and postoperative care have all resulted in dramatic improvements in the outcomes of the Norwood procedure for palliation of hypoplastic left heart syndrome. One such modification of the Norwood procedure, consisting of a right ventricle to pulmonary artery conduit to supply pulmonary blood flow instead of the modified Blalock-Taussig shunt, has been reported by various institutions to contribute to these improved outcomes. This article evaluates the current status of right ventricle to pulmonary artery shunt modification of the Norwood procedure with special emphasis on its impact on early and interstage outcomes, as well as real and potential drawbacks of this modification.
