Norwood Operation in Hypoplastic Left Heart Syndrome. Proposal of Protocol and FirstClinical Experiences

Overview

Hypoplastic left heart syndrome (HLHS) represents congenital heart disease lethal during the early naturalcourse characterized by a small left ventricle and stenosis or atresia of both the aortic and the mitral valve. Untillrecently this heart lesion was considered to be inoperable. Considerable recent improvement of results of neonatalcardiac surgery, improvement of Norwood reconstructive surgery and perioperative care have improved theprognosis of these patients. Operative results depend on the presence of risk factors. Because of this fact, patientswith an ascending aorta less than 2.5 mm in diameter, presence of severe tricuspid regurgitation, dysfunction ofthe right ventricle, severe associated lesions, chromosomal aberrations, severe acquired lesions, weight less than2.5 kg, patients older than 6 weeks and neonates, whose parents did not agree with the surgical treatment, are notindicated for operation. Out of 8 operated neonates with this heart disease, two (25%) died during the earlypostoperative period. Our early experiences with the surgical treatment of HLHS are encouraging.

Key words:
congenital heart disease, hypoplastic left heart syndrome, cardiac surgery, Norwood operation,