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Clinical Procedure
 
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The narrow aorta is reconstructed with the aid of the pulmonary artery and then either a blalock taussig-shunt or RV PA-conduit (Sano shunt) is created to supply pulmonary blood flow.

This is the first of three stages in the pathway towards a Fontan circulation.

Illustration from N Engl J Med. 2010 May 27; 362(21): 1980–1992.

Comparison of shunt types in the Norwood Procedure for Single-Ventricle Lesions

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Indicated in the management of HLHS.
Performed as a neonate.

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The goal at induction is to maintain an adequate balance between systemic and pulmonary blood flow to ensure adequate end organ perfusion and oxygenation.

This can be achieved by aiming for a relatively high pulmonary vascular resistance by inducing a mild respiratory acidosis and avoiding over oxygenation.

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If heart performance is poor coming of pump following a Norwood procedure and all medical causes have been ruled out, consider temporarily clamping the blalock thomas-taussig-shunt. This will transiently increase blood flow to, and flush, the coronary arteries.

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