related proximal left pulmonary artery stenosis can be alleviated successfully at the time of hemi-Fontan or Fontan completion. However, left pulmonary artery compression appears to be resilient to surgical recon- struction, although it can be effectively alleviated in the catheterization laboratory via endovascular stent- ing. Even acquired atresia of the proximal left pulmo- nary artery after the hemi-Fontan procedure has been successfully reconstructed using stenting techniques. 4 Abnormalities of the proximal right and left pulmonary arteries occur in approximately 50% of patients after the Norwood stage I procedure for hypoplastic left heart syndrome, leading to asym- metric pulmonary artery growth and a trend to- ward a decreasing Nakata index over time. The long-term sequelae of these findings in Fontan pa- tients and their clinical status are unknown at this time and require long-term follow-up. 1. Mietus-Snyder M, Lang P, Mayer JE, Jones RA, Castanda AR, Lock JE. Childhood systemic-pulmonary shunts. Subsequent suitability for Fontan opera- tion (abstr). Circulation 1987;76(suppl III):III–39. 2. Alboliras ET, Chin AJ, Barber G, Helton G, Pigott JD, Norwood WL. Pulmonary artery configuration after palliative operations for hypoplastic left heart syndrome. J Thorac Cardiovasc Surg 1989;97:878 –885. 3. Chang AC, Farrell PE, Murdison KA, Baffa JM, Barber G, Norwood WI, Murphy JD. Hypoplastic left heart syndrome: hemodynamic and angiographic assessment after initial reconstructive surgery and relevance to modified Fontan procedure. J Am Coll Cardiol 1991;17:1143–1149. 4. Moore JW, Schneider DJ. Transcatheter reconstruction using intravascular stents of acquired long-segment pulmonary artery discontinuity after the hemi- Fontan procedure associated with either congenital mitral valve stenosis or atresia and hypoplastic left ventricle. Am J Cardiol 2002;89:1225–1229. Choices Physicians Would Make If They Were the Parents of a Child With Hypoplastic Left Heart Syndrome Alexander A. Kon, MD, Lynn Ackerson, PhD, and Bernard Lo, MD W e surveyed pediatric subspecialists who are ex- perts in the care of children with hypoplastic left heart syndrome (HLHS), and asked them what they would do if faced with either a prenatal or neo- natal diagnosis of HLHS in their own child. Further- more, we assessed what factors influenced the deci- sions physicians stated that they would make, partic- ularly perceived outcomes of surgery and physicians’ personal characteristics. Under the doctrine of in- formed consent, physicians give parents information regarding various treatment options and likely out- comes. However, if physicians who were knowledge- able on the topic, placing themselves in the position of the parent of an affected child, did not regard out- comes as the primary factor in their decision-making, it may be more appropriate to use a different model of obtaining informed consent for treatment of HLHS, a model that gives more weight to personal values. ••• A 10-page survey was constructed and mailed to all attending physicians in the sections of neonatology, pe- diatric critical care, pediatric cardiology, and congenital cardiac surgery at the largest pediatric cardiac surgery centers in the United States. Each subject was assigned a unique identifying number, which was stamped on the return envelope to allow tracking. Surveys were mailed in the fall of 1999, and all nonresponders were sent a follow-up letter as well as a second copy of the survey via fax. The research protocol was approved by the University of California, San Francisco, human subjects review committee. Return of the questionnaire was in- terpreted as indicating informed consent. Major United States pediatric cardiac centers were grouped into 3 tiers: moderate volume, high volume, From the Section of Pediatric Critical Care Medicine and the Program in Bioethics at the University of California Davis, Davis, California; Kaiser Research Foundation, Oakland, California; and Program in Medical Ethics at the University of California San Francisco, San Francisco, California. This project was funded by a grant from the Kadima Foundation, Mill Valley, California, and by the University of California, San Francisco Department of Pediatrics, San Francisco, California. Dr. Kon’s address is: University of California, Davis, De- partment of Pediatrics, Ticon II, Room 228, 2516 Stockton Boulevard, Sacramento, California 95817. E-mail: aakon@ucdavis.edu. Manuscript received December 27, 2002; revised manuscript re- ceived and accepted March 7, 2003. TABLE 1 Characteristics of Subjects Characteristic Value* Specialty Cardiology 103 (48%) Neonatology 59 (27%) Critical Care 31 (14%) Surgery 22 (10%) Race/ethnicity Caucasian 169 (88%) Hispanic 9 (5%) Asian 6 (3%) Indian 2 (1%) Other race/ethnicity 6 (3%) Religion Christian 111 (54%) Jewish 50 (24%) Muslim 2 (1%) Hindu 2 (1%) Buddhist 1 (1%) No religious affiliation 39 (19%) Men 152 (71%) Have children 179 (84%) Years as an attending (mean  SD) 12  14 *Not all subjects answered all questions. Percentages given are for subjects who reported for each variable. 1506 ©2003 by Excerpta Medica, Inc. All rights reserved. 0002-9149/03/$–see front matter The American Journal of Cardiology Vol. 91 June 15, 2003 doi:10.1016/S0002-9149(03)00412-0