Cardiology in the Young (2011), 21, 321–327 doi:10.1017/S1047951111000011 r Cambridge University Press, 2011 Original Article Anaesthetic and post-operative management of a modified Norwood operation for hypoplastic left heart syndrome: a retrospective series of 11 cases Yahya Yildiz, 1 Ahmet Kirbas, 2 Onur Gurer, 2 Mehmet S. Bilal 3 1 Department of Anesthesiology and Reanimation; 2 Department of Cardiothoracic Surgery, Medicana Hospitals Camlica, Uskudar; 3 Department of Cardiothoracic Surgery, Medicana Hospitals International, Buyukcekmece, Istanbul, Turkey Abstract Objective: This study aimed to describe the pre-operative and operative findings, as well as the post-operative haemodynamics of patients operated on for hypoplastic left heart. The findings of patients who survived or did not survive were also compared to anticipate the risk factors for mortality. Methods: We retrospectively reviewed the anaesthetic and intensive care records of 11 (seven male and four female) patients who underwent a modified Norwood operation as neonates. There were eight patients who survived, while three did not survive after the operation. Haemodynamics, oxygenation, and medications of patients were recorded for the pre-operative and post-operative conditions for 2 days, and compared between groups of patients who survived and those who did not. Results: The normalised modified Blalock–Taussig shunt area was 3.28, 0.57 square millimetres per kilogram (mean, standard deviation) for the group of patients who survived and 3.55, 1.4 square millimetres per kilogram for the group of patients who did not survive (p 5 0.51). The group of patients who survived had a significantly larger normalised aortic annulus area (3.3, 0.89 square millimetres per kilogram versus 1.68, 0.21 square millimetres per kilogram, p 5 0.01), lower median age (5.57 (3–8) days versus 46.67 (4–90) days, p 5 0.02), and lower weight (2.95, 0.46 kilograms versus 3.85, 0.56 kilograms, p 5 0.03) than the group of patients who did not survive. Furthermore, the group of patients who did not survive had a significantly worse pre-operative condition, lower systemic venous and arterial oxygen saturation, and need for a high dose of drugs in the pre-operative and post-operative periods (p was less than 0.05 for each variable). Conclusion: The pre-operative, operative, and post-operative findings may be related to mortality early after the modified Norwood operation for hypoplastic left heart syndrome. Keywords: Hypoplastic left heart syndrome; modified Norwood procedure; paediatric cardiac surgery; anaesthesiology Received: 11 August 2010; Accepted: 30 December 2010; First published online: 9 February 2011 H YPOPLASTIC LEFT HEART SYNDROME IS A relatively common cardiac malformation, accounting for 4–9% of children born with congenital cardiac disease. 1 Owing to improved surgical techniques and better understanding of the haemodynamics after the modified Norwood operation, early mortality in hypoplastic left heart syndrome has fallen. However, it is still 10–20% even at experienced centres. 2 Large series have documented the prevalence of early post-operative mortality, with up to 50% occurring in the first 48 hours. 3 Mortality correlates with inadequate systemic oxygen delivery caused by an imbalance in the pulmonary and systemic blood flow ratio or low cardiac output, or both. 4 Efforts to achieve balanced circulation have concentrated on control of pulmonary Correspondence to: Dr Yahya Yildiz, Department of Anesthesiology and Reanimation, Medicana Hospitals Camlica, Alemdag Cad. No: 85 Uskudar, Istanbul 34764, Turkey. Tel: 190 216 521 3030; Fax: 190 216 443 1836; E-mail: yahyayildiz@gmail.com