Role of gated cardiac computed tomographic angiography in the evaluation of postsurgical complications after stage I Norwood procedure and its implications on management: a comparative study with two-dimensional echocardiography



The Norwood procedure is the first part of a three-stage surgical palliation for patients with functionally single ventricle anatomy. Complications after the stage I operation are not uncommon. Transthoracic echocardiography (TTE) is traditionally the mainstay for evaluation.


The purpose of our study is to compare gated cardiac computed tomographic angiography (CCTA) with TTE when evaluating for postoperative complications after stage I Norwood procedure and to describe management implications.

Materials and methods

A retrospective chart review of all patients over a 4-year period who underwent nonelective urgent CCTA for suspected complications related to stage I Norwood procedure was performed. Elective CCTA studies before stage II palliation were excluded. Patient demographics, CCTA and TTE findings, as well as interventions performed, were recorded.


Thirty-four patients were included. The mean age at CCTA was 63 days (range: 4–210 days). All patients had a recent TTE with a mean time interval between TTE and CCTA of 2 days. CCTA detected 56 abnormalities in 30 patients, with 23 directly related to postsurgical complications, including shunt-related complications (10/23, 43%), Damus-Kaye-Stansel anastomotic narrowing (2/23, 9%) and neo-aortic arch/branch vessel abnormalities (11/23, 48%). These complications were managed as follows: surgery (9, 39%), catheter-based intervention (7, 30%), medical (4, 17%) and no change in management (3, 13%). TTE did not detect 8/23 (35%) findings found on CCTA, of which 75% were either managed with surgery (4/8, 50%) or catheter-based intervention (2/8, 25%).


CCTA plays an important role in detecting surgical complications after stage I Norwood procedure and demonstrates additional findings that have direct management implications.

This is a preview of subscription content, access via your institution.

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6


  1. 1.

    Tchervenkov CI, Jacobs ML, Tahta SA (2000) Congenital heart surgery nomenclature and database project: hypoplastic left heart syndrome. Ann Thorac Surg 69:S170–S179

    CAS  Article  Google Scholar 

  2. 2.

    Öhman A, El-Segaier M, Bergman G et al (2019) Changing epidemiology of hypoplastic left heart syndrome: results of a national Swedish cohort study. J Am Heart Assoc 8:e010893

    Article  Google Scholar 

  3. 3.

    Gobergs R, Salputra E, Lubaua I (2016) Hypoplastic left heart syndrome: a review. Acta Med Litu 23:86–98

    Article  Google Scholar 

  4. 4.

    Norwood WI, Lang P, Hansen DD (1983) Physiologic repair of aortic atresia-hypoplastic left heart syndrome. N Engl J Med 308:23–26

    CAS  Article  Google Scholar 

  5. 5.

    Son JS, James A, Fan CS et al (2018) Prognostic value of serial echocardiography in hypoplastic left heart syndrome. Circ Cardiovasc Imaging 11:e006983

    Article  Google Scholar 

  6. 6.

    Krupickova S, Vazquez-Garcia L, Obeidat M et al (2019) Accuracy of computed tomography in detection of great vessel stenosis or hypoplasia before superior bidirectional cavopulmonary connection: comparison with cardiac catheterization and surgical findings. Arch Cardiovasc Dis 112:12–21

    Article  Google Scholar 

  7. 7.

    Muthurangu V, Taylor AM, Hegde SR et al (2005) Cardiac magnetic resonance imaging after stage I Norwood operation for hypoplastic left heart syndrome. Circulation 112:3256–3263

    Article  Google Scholar 

  8. 8.

    Hill KD, Frush DP, Han BK et al (2017) Radiation safety in children with congenital and acquired heart disease: a scientific position statement on multimodality dose optimization from the image gently Alliance. JACC Cardiovasc Imaging 10:797–818

    Article  Google Scholar 

  9. 9.

    Han BK, Vezmar M, Lesser JR et al (2014) Selective use of cardiac computed tomography angiography: an alternative diagnostic modality before second-stage single ventricle palliation. J Thorac Cardiovasc Surg 148:1548–1554

    Article  Google Scholar 

  10. 10.

    Goo HW (2017) Serial changes in anatomy and ventricular function on dual-source cardiac computed tomography after the Norwood procedure for hypoplastic left heart syndrome. Pediatr Radiol 47:1776

    Article  Google Scholar 

  11. 11.

    Fischbach J, Sinzobahamvya N, Haun C et al (2013) Interventions after Norwood procedure: comparison of Sano and modified Blalock-Taussig shunt. Pediatr Cardiol 34:112–118

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Siddharth P. Jadhav.

Ethics declarations

Conflicts of interest


Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Salman, R., More, S.R., Ferreira Botelho, M.P. et al. Role of gated cardiac computed tomographic angiography in the evaluation of postsurgical complications after stage I Norwood procedure and its implications on management: a comparative study with two-dimensional echocardiography. Pediatr Radiol (2021).

Download citation


  • Catheter angiography
  • Children
  • Computed tomographic angiography
  • Congenital heart disease
  • Echocardiography
  • Heart
  • Hypoplastic left heart syndrome
  • Norwood procedure