Original articles: CardiovascularPatients at risk for low systemic oxygen delivery after the Norwood procedure
Section snippets
Material and methods
Between July of 1996 and September 1998, 33 patients underwent a Norwood procedure at the Children’s Hospital of Wisconsin. Superior vena cava saturation was continuously monitored (4F oximetric catheter; Abbott Labs, North Chicago, IL) and used as an approximation of mixed venous oxygen saturation (SvO2). Hourly hemodynamic data were also collected for the first 48 hours, as were demographic and survival data. All patients underwent a Norwood procedure consisting of relief of arch obstruction,
Results
Thirty-day survival was 97% (32 of 33 patients) and hospital survival was 94% (31 of 33). The early death occurred in an infant of a diabetic mother patient with aortic atresia and severe ventricular hypertrophy. The early postoperative course of this patient was marked by restrictive cardiac physiology. This patient was placed on extracorporeal membrane oxygenator support at postoperative hour 9. Although he was successfully weaned from extracorporeal membrane oxygenator, he died on
Comment
Postoperative management of the patient following the Norwood procedure is complicated by the limited reserve of the neonatal single ventricle, as well as the parallel arrangement of the systemic and pulmonary circuits. Excessive pulmonary blood flow at the expense of systemic blood flow is a common postoperative scenario that can lead to death 4, 6. Analysis of SvO2 and SaO2 data are the only methods to differentiate the possible causes of decreased systemic oxygen delivery, permitting early
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