Document Detail


Modified Norwood operation for single left ventricle and ventriculoarterial discordance: an improved surgical technique.
MedLine Citation:
PMID:  9354539     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Patients with univentricular hearts and ventriculoarterial discordance with potentially obstructed systemic blood flow continue to pose difficult management problems. The goals of neonatal palliative operations are to control pulmonary blood flow while avoiding pulmonary artery distortion, to relieve systemic outflow tract obstruction, and to avoid heart block. METHODS: Between January 1987 and December 1996, 38 patients with either tricuspid atresia or a double-inlet left ventricle and ventriculoarterial discordance underwent a modified Norwood procedure. Their mean age was 15 days, and their mean weight was 3.4 kg. Aortic arch anomalies were present in 92% of the patients. Morbidity and mortality statistics, intraoperative data, and postoperative echocardiograms were reviewed. RESULTS: There were 3 early deaths (7.8%) and 5 late deaths (13.1%). The actuarial survival rates at 1 month, 1 year, and 5 years were 89%, 82%, and 71%, respectively. Follow-up was complete in all children at a mean interval of 30 +/- 9 months. None of the patients had significant neoaortic valve insufficiency, and 1 patient required therapy for residual aortic arch obstruction. Nine patients (30% of the survivors) have undergone the hemi-Fontan procedure, and 18 patients (60%) successfully have undergone the Fontan procedure. CONCLUSIONS: In this patient population, we recommend the modified Norwood procedure as the neonatal palliative treatment of choice. It can be performed with acceptable early morbidity and mortality, and it improves suitability for the Fontan procedure. It reliably relieves all levels of systemic outflow tract obstruction, controls pulmonary blood flow, and avoids heart block.
Authors:
R S Mosca; H A Hennein; T J Kulik; D C Crowley; E C Michelfelder; A Ludomirsky; E L Bove
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  64     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1997 Oct 
Date Detail:
Created Date:  1997-11-13     Completed Date:  1997-11-13     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1126-32     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, The University of Michigan School of Medicine, Ann Arbor 48109, USA. rmosca@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Abnormalities, Multiple / mortality,  surgery*
Actuarial Analysis
Aorta / abnormalities,  surgery*
Cardiac Surgical Procedures / methods
Heart Defects, Congenital / mortality,  surgery
Heart Ventricles / abnormalities*,  surgery
Humans
Infant
Infant, Newborn
Palliative Care*
Survival Rate
Tricuspid Atresia / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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