title: Considerations in biventricular repair after the Norwood procedure.
abstract: OBJECTIVE
  The Norwood procedure can be applicable as a first stage palliation in children who can eventually undergo a biventricular repair. Although usual management of these patients is a primary neonatal repair, in selected patients staged approach with a Norwood procedure in the neonatal period followed by a Rastelli procedure in the infancy for conversion to two-ventricle physiology has been used alternatively.
  
  
  METHODS
  We report our experiences on two infants who underwent a previous palliation with the Norwood procedure for lesions other than hypoplastic left heart syndrome and converted to two-ventricle physiology by the use of a Rastelli-type procedure. This report examines considerations in biventricular repair after the Norwood procedure especially need for ventricular septal defect enlargement and approach to placement of the right ventricle to pulmonary artery conduit.
  
  
  RESULTS
  Both of the infants who underwent staged approach with an initial Norwood procedure for lesions other than hypoplastic left heart syndrome survived the operations and were clinically well at mid-term follow-up.
  
  
  CONCLUSIONS
  In selected patients, the staged approach is an alternative in management of malformations other than hypoplastic left heart syndrome which share the important physiologic features of aortic outlet obstruction and ductal dependency of systemic circulation. We recommend routine enlargement of ventricular septal defect and proper positioning of the conduit at the time of subsequent biventricular repair.
authors.affiliation: Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, SC USA.
authors.forename: F
authors.initials: F
authors.lastname: Nurozler
authors.forename: S M
authors.initials: SM
authors.lastname: Bradley
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis / Q000601:surgery*; D001013:Aorta, Thoracic / Q000002:abnormalities*; D001017:Aortic Coarctation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D001021:Aortic Valve / Q000002:abnormalities*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D006328:Cardiac Catheterization; D021922:Discrete Subaortic Stenosis / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D004374:Ductus Arteriosus, Patent / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D004452:Echocardiography; D005500:Follow-Up Studies; D018729:Fontan Procedure; D006345:Heart Septal Defects, Ventricular / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D010166:Palliative Care / Q000379:methods*; D013348:Subclavian Artery / Q000002:abnormalities*; D016019:Survival Analysis; D016896:Treatment Outcome