Over the past decade new variations on the “classic” first stage palliation (the Norwood/BT
shunt) for patients with Hypoplastic Left Heart Syndrome have emerged and been vetted
by the medical community. A “one size fits all” approach may not be adequate anymore.
In this review, the optimal indications for the various palliative options (Norwood/BT
shunt, Norwood/RV-PA conduit, Hybrid Stage I with or without ductal stenting, heart
transplantation) are reviewed from a standpoint of the initial anatomy and physiology
of the patient, letting it guide clinical management. Current knowledge useful for
decision-making is also reviewed as objectively as possible.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Seminars in Thoracic & Cardiovascular Surgery: Pediatric Cardiac Surgery AnnualAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Comparison of shunt types in Norwood procedure for single ventricle lesions.N Engl J Med. 2010; 362: 1980-1992
- Right ventricle-pulmonary artery shunt in first-stage palliation of hypoplastic left heart syndrome.J Thorac Cardiovasc Surg. 2003; 126: 504-509
- Hybrid approach for hypoplastic left heart syndrome: intermediate results after the learning curve.Ann Thorac Surg. 2008; 85: 2063-2070
- Single-ventricle palliation for high-risk neonates: the emergence of an alternative hybrid stage 1 strategy.J Thorac Cardiovasc Surg. 2006; 131: 163-171
- Results of Norwood Stage I operation: comparison of hypoplastic left heart syndrome with other malformations.J Thorac Cardiovasc Surg. 2000; 119: 358-367
- Regional low-flow perfusion provides cerebral circulatory support during neonatal aortic arch reconstruction.J Thorac Cardiovasc Surg. 2000; 119: 331-339
- Selective cerebral perfusion technique during aortic arch repair in neonates.Ann Thorac Surg. 1996; 61: 1546-1548
- Can randomized clinical trials impact the surgical approach for hypoplastic left heart syndrome?.World J Pediatr Congenit Heart Surg. 2011; 2: 445-456
- Brain volume and metabolism in fetuses with congenital heart disease: evaluation with quantitative magnetic resonance imaging and spectroscopy.Circulation. 2010; 121: 26-33
- Early developmental outcome in children with hypoplastic left heart syndrome and related anomalies: the single ventricle reconstruction trial.Circulation. 2012; 125: 2081-2091
- Introduction to the Single Ventricle Reconstruction trial.J Thorac Cardiovasc Surg. 2012; 144: 880-881
- Intermediate-term mortality and cardiac transplantation in infants with single ventricle lesions: risk factors and their interaction with shunt type.J Thorac Cardiovasc Surg. 2012; 144: 152-159
- Risk factors for hospital morbidity and mortality following the Norwood procedure: a report from the Pediatric Heart Network Single Ventricle Reconstruction Trial.J Thorac Cardiovasc Surg. 2012; 144: 882-895
- Relative impact of surgeon and center volume on early mortality following the Norwood operation.Ann Thorac Surg. 2012; 93: 1992-1997
- Measurement of technical performance in surgery for congenital heart disease: the stage I Norwood procedure.J Thorac Cardiovasc Surg. 2008; 136: 993-997
- Predictors of technical success and postnatal biventricular outcome after in utero aortic valvuloplasty for aortic stenosis with evolving hypoplastic left heart syndrome.Circulation. 2009; 120: 1482-1490
- Precise evaluation of bilateral pulmonary artery banding for initial palliation in high-risk hypoplastic left heart syndrome.J Thorac Cardiovasc Surg. 2010; 140: 1084-1091
- Pulmonary artery banding before Norwood procedure.Ann Thorac Surg. 2003; 75: 1008-1010
- Use of mathematical modeling to compare and predict hemodynamic effects between hybrid and surgical Norwood palliations for hypoplastic left heart syndrome Modeling of Congenital Hearts Alliance (MOCHA) Investigators.Circulation. 2011; 124: S204-S210
- The retrograde aortic arch in the hybrid approach to hypoplastic left heart syndrome.Ann Thorac Surg. 2009; 88: 1939-1946
- Intact or restrictive atrial septum: improved results from a single center.Pediatr Cardiol. 2012; (Epub ahead of press)
- Surgical outcome for patients with the mitral stenosis-aortic atresia variant of hypoplastic left heart syndrome.J Thorac Cardiovasc Surg. 2008; 135: 339-346
- Interstage mortality after the Norwood procedure: results of the multicenter Single Ventricle Reconstruction trial.J Thorac Cardiovasc Surg. 2012; 144: 896-906
- The complex relationship between center volume and outcome in patients undergoing the Norwood operation.Ann Thorac Surg. 2012; 93: 1556-1562
- The complex relationship between pediatric cardiac surgical case volumes and mortality rates in a national clinical database.J Thorac Cardiovasc Surg. 2009; 137: 1133-1140
- Hospital mortality for Norwood and arterial switch operations as a function of institutional volume.Pediatr Cardiol. 2008; 29: 713-717
- Mortality in hypoplastic left heart syndrome: review of 216 autopsy cases of aortic atresia with attention to coronary artery disease.J Thorac Cardiovasc Surg. 2012; 144: 1301-1306
- Impact of mitral stenosis and aortic atresia on survival in hypoplastic left heart syndrome.Ann Thorac Surg. 2008; 85: 2057-2062
- Hypoplastic left heart syndrome and aortic atresia-mitral stenosis variant: role of myocardial protection strategy and impact of ventriculo-coronary connections after stage I palliation.Pediatr Cardiol. 2011; 32: 929-939
- Acute kidney injury and regional abdominal perfusion during neonatal aortic arch reconstruction.J Thorac Cardiovasc Surg. 2010; 140: 453-458
- The modified Norwood palliation on a beating heart.J Thorac Cardiovasc Surg. 1999; 118: 1130-1132
- Hybrid procedure as an alternative to surgical palliation of high-risk infants with hypoplastic left heart syndrome and its variants.J Thorac Cardiovasc Surg. 2010; 139: 1211-1215
- Hard choices for high-risk patients with critical left ventricular outflow obstruction: contemporary comparison of hybrid versus surgical strategy.World J Pediatr Congenit Heart Surg. 2010; 1: 187-193
- Perinatal and early surgical outcome for the fetus with hypoplastic left heart syndrome: a 5-year single institutional experience.Ultrasound Obstet Gynecol. 2010; 36: 465-470
- Right ventricle and tricuspid valve function at midterm after the Fontan operation for hypoplastic left heart syndrome: impact of shunt type.Pediatr Cardiol. 2011; 32: 160-166
Article info
Identification
Copyright
© 2013 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
