Original articleCardiovascularMixed Venous Oxygen Saturation Monitoring After Stage 1 Palliation for Hypoplastic Left Heart Syndrome
Section snippets
Patients
As of June 2006, 178 consecutive patients represent a single-center, 10-year experience with staged palliation for all patients with hypoplastic left heart syndrome (HLHS) or other variants of congenital heart disease with systemic outflow obstruction. This time period represents the use of continuous Svo2 monitoring for the postoperative management of patients who underwent stage 1 palliation (S1P). As previously described, a 4F oximetric catheter (Abbot Laboratories, North Chicago, IL) was
Results
Aortic atresia was present in 68% of patients (79/116), with associated mitral valve atresia in 58 and a patent mitral valve in 21. Aortic stenosis occurred in 32% (37/116), and a restrictive ventricular septal defect was present in 11% of the patients (13/116) with aortic stenosis. The native ascending aorta measured 3.3 ± 1.5 mm, and 41% (48/116) had a native aortas of less than 2.5 mm. Boys comprised 65% of the patients (75/116), and 43% (75/116) were diagnosed in utero, with prenatal
Comment
The early postoperative period after the Norwood procedure is one of high risk due to the compounding of several physiologic vulnerabilities. The single right ventricle is an inferior power source further compromised by a recent period of ischemia and CPB. With limited cardiac output, precise partitioning of the pulmonary and systemic flow is necessary to achieve adequate tissue oxygen delivery. The combination of decreased cardiac output and the inherent inefficiencies of parallel circulation
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