Right ventricle to pulmonary artery shunt modification of the Norwood procedure

Over the last quarter of a century, improvements in antenatal diagnosis, preoperative care, neonatal surgical techniques, arch reconstruction, cardiopulmonary bypass strategies, catheter-based interventions and postoperative care have all resulted in dramatic improvements in the outcomes of the Norwood procedure for palliation of hypoplastic left heart syndrome. One such modification of the Norwood procedure, consisting of a right ventricle to pulmonary artery conduit to supply pulmonary blood flow instead of the modified Blalock-Taussig shunt, has been reported by various institutions to contribute to these improved outcomes. This article evaluates the current status of right ventricle to pulmonary artery shunt modification of the Norwood procedure with special emphasis on its impact on early and interstage outcomes, as well as real and potential drawbacks of this modification.