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Anaesthetic and post-operative management of a modified Norwood operation for hypoplastic left heart syndrome: a retrospective series of 11 cases

Published online by Cambridge University Press:  09 February 2011

Yahya Yildiz ,
Ahmet Kirbas ,
Onur Gurer  and
Mehmet S. Bilal
Yahya Yildiz*
Affiliation:
Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Uskudar, Istanbul, Turkey
Ahmet Kirbas
Affiliation:
Department of Cardiothoracic Surgery, Medicana Hospitals Camlica, Uskudar, Istanbul, Turkey
Onur Gurer
Affiliation:
Department of Cardiothoracic Surgery, Medicana Hospitals Camlica, Uskudar, Istanbul, Turkey
Mehmet S. Bilal
Affiliation:
Department of Cardiothoracic Surgery, Medicana Hospitals International, Buyukcekmece, Istanbul, Turkey
*
Correspondence to: Dr Yahya Yildiz, Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Alemdag Cad. No: 85 Uskudar, Istanbul 34764, Turkey. Tel: +90 216 521 3030; Fax: +90 216 443 1836; E-mail: yahyayildiz@gmail.com
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Abstract

Objective

This study aimed to describe the pre-operative and operative findings, as well as the post-operative haemodynamics of patients operated on for hypoplastic left heart. The findings of patients who survived or did not survive were also compared to anticipate the risk factors for mortality.

Methods

We retrospectively reviewed the anaesthetic and intensive care records of 11 (seven male and four female) patients who underwent a modified Norwood operation as neonates. There were eight patients who survived, while three did not survive after the operation. Haemodynamics, oxygenation, and medications of patients were recorded for the pre-operative and post-operative conditions for 2 days, and compared between groups of patients who survived and those who did not.

Results

The normalised modified Blalock–Taussig shunt area was 3.28, 0.57 square millimetres per kilogram (mean, standard deviation) for the group of patients who survived and 3.55, 1.4 square millimetres per kilogram for the group of patients who did not survive (p = 0.51). The group of patients who survived had a significantly larger normalised aortic annulus area (3.3, 0.89 square millimetres per kilogram versus 1.68, 0.21 square millimetres per kilogram, p = 0.01), lower median age (5.57 (3–8) days versus 46.67 (4–90) days, p = 0.02), and lower weight (2.95, 0.46 kilograms versus 3.85, 0.56 kilograms, p = 0.03) than the group of patients who did not survive. Furthermore, the group of patients who did not survive had a significantly worse pre-operative condition, lower systemic venous and arterial oxygen saturation, and need for a high dose of drugs in the pre-operative and post-operative periods (p was less than 0.05 for each variable).

Conclusion

The pre-operative, operative, and post-operative findings may be related to mortality early after the modified Norwood operation for hypoplastic left heart syndrome.

Keywords

Hypoplastic left heart syndromemodified Norwood procedurepaediatric cardiac surgeryanaesthesiology
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 3 , June 2011 , pp. 321 - 327
Copyright
Copyright © Cambridge University Press 2011

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References

1. Chen, Q, Parry, AJ. The current role of hybrid procedures in the stage 1 palliation of patients with hypoplastic left heart syndrome. Eur J Cardiothorac Surg 2009; 36: 77–83.CrossRefGoogle ScholarPubMed
2. Tweddell, JS, Hoffman, GM, Fedderly, RT, et al. Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure. Ann Thorac Surg 1999; 67: 161–167.CrossRefGoogle ScholarPubMed
3. Gaynor, JW, Mahle, WT, Cohen, MI, et al. Risk factors for mortality after the Norwood procedure. Eur J Cardiothorac Surg 2002; 22: 82–89.CrossRefGoogle ScholarPubMed
4. Charpie, JR, Dekeon, MK, Goldberg, CS, Mosca, RS, Bove, EL, Kulik, TJ. Postoperative hemodynamics after Norwood palliation for hypoplastic left heart syndrome. Am J Cardiol 2001; 87: 198–202.CrossRefGoogle ScholarPubMed
5. Tabbutt, S, Ramamoorthy, C, Montenegro, LM, et al. Impact of inspired gas mixtures on preoperative infants with hypoplastic left heart syndrome during controlled ventilation. Circulation 2001; 104: I159–I164.CrossRefGoogle ScholarPubMed
6. Naguib, AN, Winch, P, Schwartz, L, et al. Anesthetic management of the hybrid stage 1 procedure for hypoplastic left heart syndrome (HLHS). Paediatr Anaesth 2010; 20: 38–46.CrossRefGoogle ScholarPubMed
7. Brann, S, Brawn, WJ, Raafat, F, Sreeram, N. Neonatal pulmonary vascular disease in hypoplastic left heart syndrome. Ann Thorac Surg 1995; 60: 433–434.CrossRefGoogle ScholarPubMed
8. Photiadis, J, Urban, AE, Sinzobahamvya, N, et al. Restrictive left atrial outflow adversely affects outcome after the modified Norwood procedure. Eur J Cardiothorac Surg 2005; 27: 962–967.CrossRefGoogle ScholarPubMed
9. Long, D, Horn, D, Keogh, S. A survey of sedation assessment and management in Australian and New Zealand paediatric intensive care patients requiring prolonged mechanical ventilation. Aust Crit Care 2005; 18: 152–157.CrossRefGoogle ScholarPubMed
10. Leyvi, G, Wasnick, JD. Single-ventricle patient: pathophysiology and anesthetic management. J Cardiothorac Vasc Anesth 2010; 24: 121–130.CrossRefGoogle ScholarPubMed
11. Photiadis, J, Hübler, M, Sinzobahamvya, N, et al. Does size matter? Larger Blalock-Taussig shunt in the modified Norwood operation correlates with better hemodynamics. Eur J Cardiothorac Surg 2005; 28: 56–60.CrossRefGoogle ScholarPubMed
12. De Oliveira, NC, Ashburn, DA, Khalid, F, et al. Prevention of early sudden circulatory collapse after the Norwood operation. Circulation 2004; 110 (11 Suppl 1): II133–II138.CrossRefGoogle ScholarPubMed
13. Hoffman, GM, Ghanayem, NS, Kampine, JM, et al. Venous saturation and the anaerobic threshold in neonates after the Norwood procedure for hypoplastic left heart syndrome. Ann Thorac Surg 2000; 70: 1515–1520.CrossRefGoogle ScholarPubMed
14. Wright, GE, Crowley, DC, Charpie, JR, Ohye, RG, Bove, EL, Kulik, TJ. High systemic vascular resistance and sudden cardiovascular collapse in recovering Norwood patients. Ann Thorac Surg 2004; 77: 48–52.CrossRefGoogle ScholarPubMed
15. Lister, G, Moreau, G, Moss, M, Talner, NS. Effects of alterations of oxygen transport on the neonate. Semin Perinatol 1984; 8: 192–204.Google ScholarPubMed
16. Buchhorn, R, Ross, RD, Hulpke-Wette, M, et al. Effectiveness of low dose captopril versus propranolol therapy in infants with severe congestive failure due to left-to-right shunts. Int J Cardiol 2000; 76: 227–233.CrossRefGoogle ScholarPubMed