Echocardiographic Features and Complications of the Modified Norwood Operation Using the Right Ventricle to Pulmonary Artery Conduit

Hypoplastic left heart syndrome remains a major contributor to mortality from congenital heart disease. 1-4 Staged surgical palliation has continued to improve intermediate-term survival; however, stage I operative mortality and interstage attrition remain problematic. 3,5 A modification of the Norwood procedure using a right ventricle (RV) to pulmonary artery (PA) conduit (RV-PA) in place of the modified Blalock-Taussig shunt, has recently gained favor. 6,7 Data suggest that this technique may improve hemodynamics in the immediate postoperative period by limiting diastolic runoff from the systemic circulation, thus, maintaining coronary perfusion. 8-10 Various authors have illustrated isolated echocardiographic features of the RV-PA modification. 7,8,11,12 With an increasing number of institutions adopting this surgical approach, familiarity with the echocardiographic features of the patient who has undergone RV-PA becomes important. The aim of this report is to provide a comprehensive description of the typical echocardiographic evaluation of the RV-PA modified Norwood operation. In addition, we also report the echocardiographic appearance of several complications that may occur within this patient population.