Original ArticlesCauses of Death After the Modified Norwood Procedure: A Study of 122 Postmortem Cases☆
Section snippets
Material and Methods
Between January 1980 and December 1995, autopsies were performed on 122 patients who died after undergoing the Norwood procedure (stage I palliation) for the hypoplastic left heart syndrome at the Children’s Hospital in Boston, Massachusetts.
We reexamined the heart specimens of these 122 patients with special emphasis on the pathologic anatomy, all details of the surgical palliation, the myocardial histology, and the pathologic findings. These data were correlated with the clinical, cardiac
Impairment of Coronary Arterial Perfusion
The most frequent cause of death was impairment of coronary artery perfusion (33 patients, 27%, Table 2, Table 3). Precoronary stenosis was present in 26 of these patients (21% of the series). At autopsy, the opening into the native aortic root, from which the coronary arteries almost always arose, was nonpatulous, ie, not widely patent. On initial inspection from within the reconstructed neoascending aorta, the coronary ostia could not be seen. Although the opening into the native aortic root
Comment
Before the pioneering work of Norwood and his colleagues that was published in 1980 [1], the hypoplastic left heart syndrome was essentially 100% fatal. Now, because of the steady, incremental improvements in understanding, surgical technique, and perioperative management, the modified Norwood procedure has become almost routine at major pediatric cardiovascular centers. Although the survival of such patients has improved considerably 3, 4, 5, 6, 7, there remains room for improvement.
Acknowledgements
This study was supported in part by a grant from the Deutsche Forschungsgemeinschaft.
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