Considerations in biventricular repair after the Norwood procedure

Objective: The Norwood procedure can be applicable as a first stage palliat ion in children who can eventually undergo a biventricular repair. Although usual management of these patients is a primary neonatal repair, in select ed patients staged approach with a Norwood procedure in the neonatal period followed by a Rastelli procedure in the infancy for conversion to two-vent ricle physiology has been used alternatively. Methods: We report our experi ences on two infants who underwent a previous palliation with the Norwood p rocedure for lesions other than hypoplastic left heart syndrome and convert ed to two-ventricle physiology by the use of a Rastelli-type procedure. Thi s report examines considerations in biventricular repair after the Norwood procedure especially need for ventricular septal defect enlargement and app roach to placement of the right ventricle to pulmonary artery conduit. Resu lts: Both of the infants who underwent staged approach with an initial Norw ood procedure for lesions other than hypoplastic left heart syndrome surviv ed the operations and were clinically well at mid-term follow-up. Conclusio n: In selected patients, the staged approach is an alternative in managemen t of malformations other than hypoplastic left heart syndrome which share t he important physiologic features of aortic outlet obstruction and ductal d ependency of systemic circulation. We recommend routine enlargement of vent ricular septal defect and proper positioning of the conduit at the time of subsequent biventricular repair. (C) 2000 Elsevier Science B.V. All rights reserved.