Experience with the Norwood procedure without circulatory arrest

Abstract

The Norwood procedure for hypoplastic left heart syndrome was successfully accomplished with complete avoidance of circulatory arrest by means of cerebral perfusion through the innominate artery combined with cannulation of the descending aorta. A conduit between the right ventricle and the pulmonary artery seems an excellent alternative pulmonary blood source, although right ventricular function needs to be carefully monitored.

Right ventricle-to-pulmonary artery shunt related complications after Norwood procedure☆

“…First proposed in the pioneering works of William Norwood for almost 30 years [1], and recently popularized by Japanese surgeons [2,3], the RV-PA shunt led to an ongoing debate regarding early and late hemodynamics after NP, survival and optimal preparation of the single right ventricle and pulmonary vasculature for Fontan operation. The evidence of the favorable early hemodynamics after NP associated with the RV-PA shunt has been widely reported by many centers, including ours [4][5][6].…”

Right Ventricle to Pulmonary Artery Conduit Improves Outcome After Stage I Norwood for Hypoplastic Left Heart Syndrome

“…To modulate these detrimental physiological features, the use of a right ventricle to pulmonary artery conduit (RV/PA), initially reported in the early attempts of surgical palliation for HLHS by Norwood and colleagues, 5 has been revisited. 6,7 This report compares the experience in two centers with the use of a RV to PA conduit to provide pulmonary blood flow as opposed to the conventional approach using a modified Blalock-Taussig shunt in neonates undergoing Stage I Norwood reconstruction for HLHS. No other aspect of the surgical technique or perioperative management has been altered.…”

Is unilateral brain regional perfusion neurologically safe during congenital aortic arch surgery?

“…Regional brain perfusion was introduced to avoid the neurological complications associated with circulatory arrest method [2][3][4][5][6][7].…”