The Norwood Procedure with an Innominate Artery-to-Pulmonary Artery Shunt

摘要

Norwood and colleagues reported the first successful palliation of hypoplastic left heart syndrome (HLHS) in 1983. Today, there are several competing surgical strategies for stage I palliation, including the right-ventricle-to-pulmonary-artery conduit (Sano) modification, the so-called hybrid procedure (ductal stenting and branch pulmonary artery banding), and perhaps the gold standard, the Norwood procedure with an innominate artery-to-pulmonary artery (Bla-lock-Taussig) shunt. Regardless of the surgical approach, neonatal palliation of hypoplastic left heart requires relief of systemic outflow obstruction, provision of unobstructed coronary blood flow, creation of a nonrestrictive atrial septal communication, and limitation of excessive pulmonary blood flow. Furthermore, a successful program for management of the patient with HLHS must include strategies to ensure a stable postoperative course and minimal interstage loss and should aim for optimal late netrfodevelopmental outcome. This article will detail the Norwood procedure with an innominate artery-to-pulmonary artery shunt as performed at the Children's Hospital of Wisconsin,, Like most centers, our approach has changed over time and continues to evolve. Whether or not the Sano modification supplants the modified Blalock-Taussig shunt remains to be determined, nevertheless, many of the issues are common to both procedures, and even advocates for the Sano modification may find some of this description useful.