Surgery>>>>>Congenital Heart Disease
Question 8#

Hypoplastic left heart syndrome is surgically treated with:

A. Bilateral pulmonary artery banding and stent placement in the patent ductus arteriosus
B. Norwood procedure with a Blalock-Taussig (B-T) shunt
C. Norwood procedure with a right ventricle (RV) to pulmonary artery conduit (Sano shunt)
D. All of the above

Correct Answer is D

Comment:

In 1983, Norwood and colleagues described a two-stage palliative surgical procedure for relief of hypoplastic left heart syndrome that was later modified to the currently used threestage method of palliation. Stage 1 palliation, also known as the modified Norwood procedure, bypasses the LV by creating a single outflow vessel, the neoaorta, which arises from the RV. More recently, Sano introduced a modification that includes arch reconstruction and placement of the shunt between the RV and pulmonary artery (Sano shunt), which diminishes the diastolic flow created by the classical B-T shunt and may augment coronary perfusion, resulting in improved postoperative cardiac function. A newer approach combines surgical and percutaneous techniques (hybrid procedure). The bilateral pulmonary arteries of surgically banded to restrict excess pulmonary blood flow after pulmonary vascular resistance drops and ductal stenting to maintain patency. The hybrid procedure does not require cardiopulmonary bypass.