Hypoplastic left-heart syndrome Norwood operation, transplantation, or compassionate care

In our current practice, either the Norwood operation or heart transplantation must be considered reasonable options for neonates born with hypoplastic left-heart syndrome. Clearly some children with this otherwise lethal defect have been helped by both approaches. Is it yet, in 1993, appropriate to delete compassionate care from our group of options? Despite all the advances of the past decade, we are not at the point where we can declare hypoplastic left-heart syndrome "cured" even for the survivors of the Norwood operation or heart transplantation. Compassionate care (including withdrawal of prostaglandin E1) is still appropriate for those families who feel that the chance of success and the quality of life are not great enough to justify the challenges the infants and their families must face. Clearly as technical modifications are made in the Norwood operation and as advances are made in transplantation biology, the number of families who choose compassionate care will decrease.