Effect of shunt type on echocardiographic indices after initial palliations for hypoplastic left heart syndrome: Blalock-Taussig shunt versus right ventricle-pulmonary artery conduit.

Objectives: The study objective was to compare echocardiographic indices in infants with hypoplastic left heart syndrome (HLHS) randomized to different surgical pathways.

Background: Initial surgical palliation for HLHS has evolved to two strategies that vary by source of pulmonary blood flow: a modified Blalock-Taussig (BT) shunt or a right ventricle to pulmonary artery (RV-PA) conduit.

Methods: Seventeen patients were randomized to either a BT shunt or RV-PA as their first-stage palliation, and 15 survived through bidirectional Glenn (BDG) (seven BT shunts/eight RV-PAs).

Early cavopulmonary anastomosis after Norwood procedure results in excellent Fontan outcome.

Background: Children with univentricular hearts and aortic arch obstruction are treated sequentially with Norwood procedure, superior cavopulmonary anastomosis (SCPA), and Fontan operation. Early SCPA results in lower initial O2 saturation and longer hospitalization, but not increased mortality. We sought to determine the impact of early SCPA on Fontan candidacy and outcomes.

Long-term and developmental outcomes of children with complex congenital heart disease.

As short-term survival of complex congenital heart disease continues to improve dramatically with advances in medical and surgical treatment, further efforts must be made to understand the long-term outcomes of our efforts. As survival continues to improve, cardiovascular morbidity and, equally importantly, neurodevelopmental and social outcomes must be a continual focus in our treatment of these complex patients. Further study of these effects is underway, and more is certainly warranted.

Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure.

Objectives: Hemodynamic vulnerability after the Norwood procedure for hypoplastic left heart syndrome results from impaired myocardial function, and critical inefficiency of parallel circulation. Traditional management strategies have attempted to optimize circulatory efficiency by using arterial oxygen saturation (SaO(2)) as an index of pulmonary/systemic flow balance, attempting to maintain SaO(2) within a theoretically optimal critical range of 75% to 80%. This optimal range of SaO(2) has not been verified clinically, and strategies targeting SaO(2) may be limited by the fact that SaO(2) is a poor predictor of systemic oxygen delivery.