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Norwood procedure for hypoplastic left heart syndrome: BT shunt or RV-PA conduit?
  1. Linda Edwards1,
  2. Kevin P Morris1,
  3. Ameen Siddiqui1,
  4. Deborah Harrington2,
  5. David Barron2,
  6. William Brawn2
  1. 1Department of Paediatric Intensive Care, Birmingham Children’s Hospital NHS Trust, Birmingham, United Kingdom
  2. 2Department of Cardiac Surgery, Birmingham Children’s Hospital NHS Trust, Birmingham, United Kingdom
  1. Correspondence to:
    Dr. Kevin P Morris
    Paediatric Intensive Care Unit, Birmingham Children’s Hospital NHS Trust, Steelhouse Lane, Birmingham, B4 6NH, United Kingdom; kevin.morris{at}


Background: The Norwood procedure is the first stage palliative procedure for hypoplastic left heart syndrome (HLHS). Traditionally the pulmonary circulation has been supplied via a modified Blalock Taussig (BT) shunt but a recent modification, adopted in some UK centres, substitutes a conduit between right ventricle and pulmonary arteries (RV-PA conduit). It is argued that this will result in a more favourable balance between pulmonary and systemic circulations.

Aim: To compare the early postoperative haemodynamic profile between patients undergoing a BT shunt or an RV-PA conduit.

Methods: Retrospective review in a tertiary referral PICU of 51 children with HLHS undergoing the Norwood procedure with either a BT shunt (Group 1; n = 23) or an RV-PA conduit (Group 2; n = 28). Data items were extracted at 10 set time points in the initial 96 h, postoperatively.

Results: Diastolic BP was significantly lower in Group 1 (p<0.001) with a trend towards a higher systolic BP and no difference in mean BP. No between-group differences were found in markers of pulmonary blood flow (PaO2, PaCO2, PaO2/FiO2 ratio), or in markers of systemic blood flow (blood lactate, oxygen extraction ratio), or in estimated ratio of pulmonary:systemic blood flow (Qp:Qs). Despite lower diastolic blood pressure in Group 1 renal and hepatic function did not differ over five post-operative days between groups.

Conclusions: With the exception of a higher diastolic blood pressure in the RV-PA conduit group, we found no difference in the early haemodynamic profile between patients undergoing an RV-PA conduit or a BT shunt.

  • BT, Blalock Taussig
  • CPB, cardiopulmonary bypass
  • CVP, central venous pressure
  • DHCA, deep hypothermic circulatory arrest
  • ETCO2, end-tidal carbon dioxide
  • HLHS, hypoplastic left heart syndrome
  • OE, oxygen extraction
  • PaO2, arterial partial pressure of oxygen
  • PaCO2, arterial partial pressure of carbon dioxide
  • PRVC, Pressure Regulated Volume Control
  • Qp:Qs, pulmonary:systemic blood flow
  • RV-PA, right ventricle to pulmonary artery
  • SaO2, arterial oxygen saturation
  • SvO2, venous oxygen saturation

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  • Competing interests: None declared.