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  • Title: [Early postoperative period in children with hypoplastic left heart syndrome in the comparison of classic and modified Norwood procedures].
    Author: Malec E, Januszewska K, Pajak J, Kołcz J, Mroczek T.
    Journal: Przegl Lek; 2002; 59 Suppl 1():28-33. PubMed ID: 12108068.
    Abstract:
    INTRODUCTION: The Norwood operation in neonates with hypoplastic left heart syndrome is associated with very high mortality. AIM: To compare early postoperative period in children who underwent classic operation to that in patients who underwent a new modification of the Norwood procedure. METHODS: Evaluation of the early postoperative period (72 h after the operation) in patients who underwent classic operation: Group 1 (31 children) and patients in whom modified Norwood procedure was performed: Group 2 (18 children). The surgical technique of the modified Norwood procedure was presented (right ventricle- to = pulmonary artery shunt and neo-aorta reconstruction by direct anastomosis between aortic arch and main pulmonary artery). RESULTS: In Group 1 in 15 (48.4%) children circulatory collapse occurred, requiring resuscitation, which was unsuccessful in 9 (60%) cases. In Group 2 one child died and early postoperative period of the other was uneventful. The mean circulatory arrest time in deep hypothermia was significantly (p = 0.002) shorter in Group 2 (mean: 33.7 +/- 8.7 min, range 25-53 min) than in Group 2 (mean: 54.1 +/- 6.6 min, range 41-76 min) and cardiopulmonary bypass time was not significantly prolonged (Group 1: mean 70.5 +/- 24.2 min, range 48-167 min; Group 2: mean 62.5 +/- 9.6 min, 39-84 min) (p = 0.765). In Group 2 there was significantly higher diastolic pressure 4, 8, 12, 24 and 36 h after the operation (p < 0.001, p = 0.005, p = 0.037, p = 0.017, p = 0.022, respectively). CONCLUSION: The new modification of the Norwood procedure ensures stable conditions in early postoperative period. We believe that short circulatory arrest time without prolongation of cardiopulmonary bypass time and higher diastolic pressure (the location of the proximal shunt end beneath the valve of the systemic circulation) improves the function of the heart.
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