Norwood-Sano recap - or - WHAT happened to Pat?

I've mentioned in the blog before that the surgery Pat is called the Norwood-Sano. What the heck is that?

Normally, a human heart pumps blood Left Heart -> Body -> Right Heart -> Lungs -> Left Heart, etc. But without a left ventricle, Pat's heart can't work that way. So the doctors here did four things.

First, the ductus arteriosus (the DA) - the connection between the Pulmonary Artery (the artery from the right side of the heart) and the Aorta (the artery from the left side of the heart) - is cut. That was what was keeping him alive, but after this surgery it's not needed anymore. All babies are born with the DA open, and it closes usually in the first week after birth. Unfortunately, that was what was keeping Pat alive, so his was being kept artificially open using a drug called prostiglandin. Prostiglandin has other side effects (poor temperature control, discomfort, etc.) and can't be kept up for long.

Next, the Aorta - normally the largest artery in the body - is very small for HLHS babies. The doctors cut his undersized aorta off of the heart and cut a slit along its length. They then sewed on tissue to make it a much larger artery.

Third, they sever the Pulmonary Artery, sew shut the side opposite the heart, and sew the newly enlarged Aorta onto valve the Pulmonary Artery used to attach to.

Finally, they install a gore-tex tube from inside the right ventricle and attach it to the Pulmonary Artery. The picture below (shamelessly lifted from www.pted.org) shows what the heart looks like after the Norwood-Sano is complete.

This is what Pat's heart looks like now. That's a big change. But after recovery he will be able to live without prostiglandin, and will be able to get big enough for the next procedure, the Glenn Shunt.

In the Glenn shunt they remove the gore-tex tube, sever the Superior Vena Cava, and attach it directly to the pulmonary artery. The picture below - lifted from www.cincinnatichildrens.org - shows the shunt on a HRHS heart. It labels the Superior Vena Cava as "3". The "4" is a Blalock-Taussig Shunt (B-T Shunt) being removed (The Sano Modification is now usually used instead of B-T for HLHS babies). After this surgery, all the blood returning from Pat's head and shoulders will go straight to the lungs without going through the heart.
Finally, when Pat is between 3 and 5 years old, the final surgery will extend the Inferior Vena Cava using more gore-tex ("5" in the chart below from www.cincinnatichildrens.org) past the heart to the pulmonary artery. Pat will then have a two-chamber heart, and may not ever need another heart surgery. We hope.