Norwood procedure to hypoplastic left heart syndrome

Since March 1992, 25 neonates and small infants with HLHS have undergone a modified Norwood procedure. The mean age and weight at operation were 17 days (2 days-2 months) and 2.7 kg (1.6-3.3 kg). Isolated cerebral and/or myocardial perfusion (ICMP) with direct anastomosis of aorta and pulmonary artery was utilized since January 1995 to 16 patients. Under median sternotomy, PTFE graft (usually 3.0-3.5 mm) was anastomosed to the brachiocephalic artery and the arterial cannula was inserted to this PTFE graft. The left carotid and the left subclavian arteries were snared and a clamp was placed on the aortic arch just distal to the brachiocephalic artery. This allowed blood to enter the brain and the coronary arteries, keeping the brain perfused and the heart-beating. After reconstruction of distal aortic arch, a single dose of crystalloid cardioplesia was infused and the rest of the arch was reconstructed. There were 14 early deaths (56%) and 4 late deaths (16%). Bidirectional Glenn procedure was performed to 5 patients with 1 death. Three patients underwent modified Fontan procedure without mortality. Mean aortic cross clamp time was 24 min. and mean ICMP time was 32 min. There was no neurologic complications. In conclusion, isolated cerebral and/or myocardial perfusion may offer an advantage of protecting the brain and myocardium during arch in Norwood procedure.