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DOI: 10.1055/s-0035-1544527
Modification of the Norwood Procedure for an Unusual Anatomy of Heart and Supraaortic Blood Vessels
Objectives: The Norwood procedure is a suitable surgical option for malformations beyond the hypoplastic left heart syndrome. We report here a case of an unusually complex cardiac and vascular anatomy, which was treated with a modification of the Norwood procedure.
Patient: A newborn presented with a double-inlet left ventricle, a L-transposition of great arteries, a dysplastic tricuspid valve and a narrow subaortic outflow tract with a restrictive VSD. In addition, an interrupted aortic arch type B was combined with an obliterated brachiocephalic artery, which itself originated from the right pulmonary artery. A small cerebral infarction within the right hemisphere and an obstruction of the left main bronchus complicated the clinical situation.
Results: At 3 weeks of age we performed bilateral pulmonary banding followed by a ductal stenting. At 11 months a modified Norwood procedure was performed. The ascending aorta and pulmonary artery were connected through an aortopulmonary window after detachment of pulmonary arteries. The PDA stent remained in situ and a 4 mm BT-shunt was inserted between the reconstructed aorta and the PA-bifurcation. Another 4 mm Goretex prosthesis was anastomosed between the obliterated brachiocephalic artery and the reconstructed aorta to achieve antegrade flow. The obstruction of the left bronchus was relieved. The chest remained open and was closed on the next day. The postoperative period was uneventful. The bidirectional Glenn-Operation was performed at 20 months of age without any complication.
Conclusion: Our combination of hybrid approach and modification of the Norwood procedure provided a successful staged repair of the complex anatomy and allowed a normal development of the currently 25 months old child.