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The Annals of Thoracic Surgery, Vol 52, 688-695, Copyright © 1991 by The Society of Thoracic Surgeons
WI Norwood Jr
The evolution of the present approach to the newborn with hypoplastic left
heart is outlined. Preoperatively, maintenance of ductal patency with
prostaglandin E1 and balancing of systemic and pulmonary blood flow are
essential. Operative details of the first-stage palliation and the
definitive second-stage procedure are described. The more recent adoption
of an intermediate-stage hemi-Fontan procedure is also described. Since
January 1989, 151 patients have been treated using this three-stage
approach, with 109 early survivors. Seventy-eight have undergone the
hemi-Fontan operation with nine deaths (5 of whom came to this stage early
nonelectively because of shunt failure or ventricular dysfunction).
Twenty-seven of the 78 patients undergoing hemi-Fontan operation have
subsequently undergone definitive Fontan procedures with no deaths.
ARTICLES
Hypoplastic left heart syndrome
Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia.
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