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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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