Prevention of Early Sudden Circulatory Collapse After the Norwood Operation

Abstract

Background-After modifications in our perioperative management protocol, we have observed a decrease in sudden circulatory collapse after the Norwood operation. The current study examines early outcomes after the Norwood operation in our unit in an attempt to identify variables that may have altered the risk of unexpected circulatory collapse. Methods and Results-We studied 105 consecutive neonates who underwent a Norwood operation in our institution. Our treatment protocol has changed in the past 3 years to include the use of alpha-blockade with phenoxybenzamine (POB) for systemic afterload reduction and selective cerebral perfusion. Forty-eight infants had selective cerebral perfusion. Forty-two infants received POB. Sixty patients had hypoplastic left heart syndrome.

Specific Injuries Management in the Postoperative of Congenital Heart Diseases (II): Univentricular Hearts

“…For this reason, some groups considered a contraindication to perform this operation, at least at this early stage, prematurity, weight below 2.5 kg, significant ventricular dysfunction, significant tricuspid regurgitation, the presence of anomalous pulmonary venous drainage total obstruction and the presence of other severe associated malformations. These conditions can contraindicate surgery up to 25% of patients with this diagnosis [1] [2].…”

The role of milrinone in children with cardiovascular compromise: review of the literature

“…Although the authors identified optimal surgical technique as the most important predictor of early survival, the use of aggressive afterload reduction with phenoxybenzamine reduced the risk of early sudden arrest [14].…”

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“…In the case of critical aortic stenosis, early in utero relief of the obstruction is thought to reverse the progression toward left ventricular hypoplasia (De Oliveira et al, 2004;Tweddell et al, 2002). As hypoplastic left heart syndrome is one of the most severe congenital heart defects that requires multistaged palliative surgery or even heart transplantation, severe aortic valve stenosis is the defect for which fetal intervention is most likely to be considered (Brown et al, 2003;McCrindle et al, 2001;McElhinney et al, 2005).…”