Results of modified Norwood's operation for hypoplastic left heart syndrome.
OBJECTIVE
The aim of the study was to analyze intermediate results of treatment of the hypoplastic left heart syndrome based on selective indication criteria.


METHODS
Between February 1997 and May 1999 38 patients with hypoplastic left heart syndrome (n=35), or with functional variant of hypoplastic left heart syndrome (n=3) were admitted to our department. Contraindications for surgery were birth weight <2500 g, diameter of ascending aorta <2 mm, severe tricuspid regurgitation persisting after initial stabilization, pulmonary regurgitation more than mild, dysfunction of the systemic right ventricle and failure to effectively resuscitate circulation before surgery.


RESULTS
Based on these criteria surgery was not indicated in 17 patients. Twenty-one infants were operated on by modified Norwood's procedure using only autologous great vessel tissue for reconstruction of systemic outflow. Overall hospital mortality was 14% (three patients). Eighteen survivors (86%) were discharged with well-balanced circulation. There was one late death (5%). Thirteen patients had already undergone the second stage (bi-directional Glenn) with no death. The mean follow-up was 13. 2+/-9.1 months (range 4-32 months). Considering both early and late events the probability of survival for the whole group (n=21) from the time of surgery was 86% at 1 month, 80% at 12 months, and it remained unchanged at 18 and 24 months of follow-up.


CONCLUSIONS
Only a limited number of European countries offer surgical treatment of hypoplastic left heart syndrome. Promising intermediate results (80% survival rate after stage I and II) achieved at our department do not only reflect overcoming the learning curve but also a selective approach to indication for surgery as well. In a country with limited resources selective approach to the patients with hypoplastic left heart syndrome is justified.
Department of Cardiovascular Surgery, Children's University Hospital, Limbova 1, 833 40, Bratislava, Slovak Republic. Hraska@dkch.dfnsp.sk
V
V
Hraska
M
M
Nosál
P
P
Sýkora
V
V
Soják
M
M
Sagát
P
P
Kunovský
D002315:Cardiopulmonary Bypass; D018610:Heart Bypass, Right / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000401:mortality / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome