title: Hypoplastic left heart syndrome with intact atrial septum: case report.
abstract: OBJECTIVE
  Hypoplastic left heart syndrome (HLHS) with an intact atrial septum (IAS) is a rare finding, reported in only 1% of pathologic specimens with hypoplasia of the aortic tract complex. In newborns with left heart obstruction, the existence of an interatrial communication is very important for oxygenated blood to be distributed to the body and to prevent pulmonary congestion. The ability to predict prenatally restriction of the atrial defect may allow earlier surgery to be planned.
  
  
  METHODS
  We report a case of prenatal diagnosis of HLHS with a complete premature closure of the foramen ovale that was not detected by prenatal echocardiography.
  
  
  CONCLUSIONS
  The management of neonates with HLHS in the first days of life is crucial to the results of the first stage of the Norwood procedure. We suggest that delivery of the mother close to surgical centre and avoiding neonatal transfer improve the results, but stabilisation with prostaglandins and balancing of the systemic and pulmonary resistances are also important. A restrictive or closed atrial septal defect may contribute to haemodynamic instability in the first days of life. The ability to predict this complication prenatally may help in the immediate postnatal management of the affected infant.
authors.affiliation: Department of Gynaecological Sciences and Human Reproduction, University of Padova, Padova, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Cester
authors.forename: Kimta
authors.initials: K
authors.lastname: Nanhorngue
authors.forename: Irene
authors.initials: I
authors.lastname: Pascoli
authors.forename: Greta
authors.initials: G
authors.lastname: Garofano
authors.forename: Nicola
authors.initials: N
authors.lastname: Surico
authors.forename: Delia Maria
authors.initials: DM
authors.lastname: Paternoster