The modified norwood procedure for hypoplastic left heart syndrome: Early to intermediate results of 120 patients with particular reference to aortic.

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Presentation transcript:

The modified norwood procedure for hypoplastic left heart syndrome: Early to intermediate results of 120 patients with particular reference to aortic arch repair Kozo Ishino, MD, Oliver Stümper, MD, Joseph J.V. De Giovanni, FRCP, Eric D. Silove, FRCP, John G.C. Wright, FRCP, Babulal Sethia, FRCS, William J. Brawn, FRCS The Journal of Thoracic and Cardiovascular Surgery Volume 117, Issue 5, Pages 920-930 (May 1999) DOI: 10.1016/S0022-5223(99)70373-9 Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 1 The cannulation technique with the arterial cannula inserted in the proximal main pulmonary artery (MPA) and the venous cannula inserted in the right atrium (RA). The left pulmonary artery (LPA) is occluded with a tourniquet, and there are also tourniquets around the cervical vessels. A polytetrafluoroethylene (PTFE) conduit is being anastomosed to the right pulmonary artery (RPA). RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 920-930DOI: (10.1016/S0022-5223(99)70373-9) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 2 A, The dotted lines show the level for transection of the main pulmonary artery (MPA), ductus arteriosus, descending aorta (D.Ao), and distal aortic arch, and the aortotomy from the aortic arch back down into the ascending aorta. B, The main pulmonary artery is transected. The patent ductus arteriosus is ligated and transected. All duct tissue, including the segment of aorta where the coarctation is normally found, is excised. The aortic arch is opened into the ascending aorta to the level of the proximal main pulmonary artery. PTFE, Polytetrafluoroethylene; LPA, left pulmonary artery; RPA , right pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 920-930DOI: (10.1016/S0022-5223(99)70373-9) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 3 A and B, The descending aorta is anastomosed to the posterior wall of the aortic arch; then to this confluence is anastomosed the proximal main pulmonary artery. A.Ao, Ascending aorta; D.Ao, descending aorta; MPA, main pulmonary artery. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 920-930DOI: (10.1016/S0022-5223(99)70373-9) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 4 After atrial septectomy, the heart is recannulated and CPB is resumed. During rewarming the proximal anastomosis of the polytetrafluoroethylene shunt is placed on the innominate artery. D.Ao, Descending aorta; MPA, main pulmonary artery; RPA, right pulmonary artery; PTFE, polytetrafluoroethylene. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 920-930DOI: (10.1016/S0022-5223(99)70373-9) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 5 The current status of all hospital survivors (82/120) after stage I palliative surgery for hypoplastic left heart syndrome. BDG, Bidirectional Glenn procedure. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 920-930DOI: (10.1016/S0022-5223(99)70373-9) Copyright © 1999 Mosby, Inc. Terms and Conditions

Fig. 6 Actuarial survival for the entire study group of 120 patients. Vertical bars enclose a 95% confidence interval. The Journal of Thoracic and Cardiovascular Surgery 1999 117, 920-930DOI: (10.1016/S0022-5223(99)70373-9) Copyright © 1999 Mosby, Inc. Terms and Conditions