Norwood Operation/Damus-Stansel-Kaye

Abstract

Fetal echocardiography and perinatal management of hypoplastic left heart syndrome (HLHS) has resulted in immediate prostaglandin administration, appropriate medical therapy, avoidance of cardiogenic shock, and safe transfer to institutions that are equipped with comprehensive management teams. The first-stage Norwood operation has undergone many changes since its introduction that have resulted in improved cardiopulmonary bypass strategies (regional perfusion techniques), standardized postoperative care methods, and anatomic modifications that have included a shunt from the right ventricle to the pulmonary artery (Sano shunt), downsizing of systemic-to–pulmonary artery shunts, and improved methods of neoaortic reconstruction to prevent stenosis. Most centers use regional perfusion techniques, the Sano shunt for systemic-to–pulmonary artery perfusion, delayed sternal closure, and home surveillance to minimize the incidence of interstage mortality.