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Ann Thorac Surg 1997;64:1795-1802
© 1997 The Society of Thoracic Surgeons

Original Articles: Cardiovascular

Causes of Death After the Modified Norwood Procedure: A Study of 122 Postmortem Cases

Ulrike Bartram, MD, Jürg Grünenfelder, MD, Richard Van Praagh, MD

Departments of Cardiology and Pathology, Children's Hospital and Harvard Medical School, Boston, Massachusetts

Accepted for publication July 19, 1997.

Background. Although the results of the modified Norwood procedure as palliation for the hypoplastic left heart syndrome have improved considerably, in-hospital mortality remains high (28% to 46%).

Methods. To establish the causes of death and consider their therapeutic applications, we reviewed our pathology experience from 1980 to 1995, inclusive, regarding 122 patients who died after undergoing the Norwood procedure.

Results. The most important causes of death were found to be impairment of coronary perfusion (33 patients, 27%), excessive pulmonary blood flow (23 patients, 19%), obstruction of pulmonary arterial blood flow (21 patients, 17%), neoaortic obstruction (17 patients, 14%), right ventricular failure (16 patients, 13%), bleeding (9 patients, 7%), infection (6 patients, 5%), tricuspid or common atrioventricular valve dysfunction (6 patients, 5%), sudden death from presumed arrhythmias (6 patients, 5%), and necrotizing enterocolitis (3 patients, 3%). In 26 patients (21%), more than one factor appeared responsible for death.

Conclusions. The leading causes of death after the Norwood procedure were found to be largely correctable surgical technical problems associated with perfusion of the lungs (36%), of the myocardium (27%), and of the systemic organs (14%).




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R. R. Clancy, S. A. McGaurn, G. Wernovsky, T. L. Spray, W. I. Norwood, M. L. Jacobs, J. D. Murphy, J. W. Gaynor, and J. E. Goin
PREOPERATIVE RISK-OF-DEATH PREDICTION MODEL IN HEART SURGERY WITH DEEP HYPOTHERMIC CIRCULATORY ARREST IN THE NEONATE
J. Thorac. Cardiovasc. Surg., February 1, 2000; 119(2): 347 - 357.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
S. H. Daebritz, G. D.A. Nollert, D. Zurakowski, P. N. Khalil, P. Lang, P. J. del Nido, J. E. Mayer Jr, and R. A. Jonas
RESULTS OF NORWOOD STAGE I OPERATION: COMPARISON OF HYPOPLASTIC LEFT HEART SYNDROME WITH OTHER MALFORMATIONS
J. Thorac. Cardiovasc. Surg., February 1, 2000; 119(2): 358 - 367.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
K. Ishino, O. Stumper, J. J. V. De Giovanni, E. D. Silove, J. G. C. Wright, B. Sethia, W. J. Brawn, and S. M. de Leval
THE MODIFIED NORWOOD PROCEDURE FOR HYPOPLASTIC LEFT HEART SYNDROME: EARLY TO INTERMEDIATE RESULTS OF 120 PATIENTS WITH PARTICULAR REFERENCE TO AORTIC ARCH REPAIR
J. Thorac. Cardiovasc. Surg., May 1, 1999; 117(5): 920 - 930.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
H. Akintuerk, I. Michel-Behnke, K. Valeske, M. Mueller, J. Thul, J. Bauer, K.-J. Hagel, J. Kreuder, P. Vogt, and D. Schranz
Stenting of the Arterial Duct and Banding of the Pulmonary Arteries: Basis for Combined Norwood Stage I and II Repair in Hypoplastic Left Heart
Circulation, March 5, 2002; 105(9): 1099 - 1103.
[Abstract] [Full Text] [PDF]


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