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Life after the Norwood procedure
  1. Ulrike E Salzer-Muhar
  1. Professor U Salzer-Muhar, Medical University of Vienna, Department of Paediatrics and Adolescent Medicine, Division of Paediatric Cardiology, Waehringer Guertel 18-20, A-1090 Vienna, Austria; Ulrike.Salzer{at}meduniwien.ac.at

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Life after the Norwood procedure (fig 1) starts when the baby is successfully weaned from cardiopulmonary bypass and, after a well-orchestrated transfer, arrives safely in the cardiac intensive care unit.1 At this time, the surgeon will usually inform the parents of the successful outcome of the operation.

Of course, life also existed before the Norwood procedure. The diagnosis of hypoplastic left heart syndrome (HLHS) would have been most likely made prenatally, probably during the early second trimester of pregnancy. This is true nowadays for the majority of patients in industrialised countries. Thus, the baby with HLHS would have caused considerable decision-making. The first decision to accept a child with HLHS would have been made by the parents after having received the diagnosis, being counselled and being given what is commonly known as informed choice concerning the termination of pregnancy.2 The next decision would have been made by the prenatal team against the likelihood of a successful and effective fetal intervention.3 Subsequently, the team would have taken decisions on a possible transfer of care to a more experienced large-volume heart centre as well as on the time and on the mode of delivery. After birth, the paediatric cardiologists, while maintaining ductal patency with prostaglandin, would have again decided on the need for a staged palliation by echocardiographic or even MRI criteria.4 The final decision would have been made in the surgical conference. Owing to severe aortic arch hypoplasia, the team would have decided against a hybrid approach and in favour of a Norwood–Sano (fig 1) procedure.1 5

Figure 1

Anatomy of hypoplastic left heart syndrome (HLHS) and stages I, II and III of palliation. For detailed description of images and operative or hybrid procedures of stage I please refer to Alsoufi et al.1

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