 An alternative to a heart transplant is the 3-Stage Surgical Procedure. The 3-Stage Procedure reconstructs the child's heart allowing it to work using only two of the heart's four chambers.
The first stage is called the Norwood procedure, or the "Modified Norwood" which was developed in 1979 by Dr. William Norwood. Because the left ventricle cannot pump blood adequately out to the body, the Norwood procedure allows the right ventricle to pump blood to both the lungs and the body. This surgery is usually performed during the baby's first week of life. A new version of this first surgery is called the "Sano Shunt." Drew had the Sano Shunt surgery performed.
The second stage procedure, called the Hemi-Fontan or Bidirectional Glenn, reduces the work of the right ventricle by allowing it to pump blood only to the body, and allowing most of the blood to flow automatically from the body into the lungs. The second stage is performed when the pressure in the baby's lungs has decreased, no longer requiring the pumping action of the right ventricle to get blood into the lungs. This surgery is usually performed at about 4-6 months of age when the traditional Norwood has been performed. When the Sano Shunt is performed, the second surgery usually needs to be done earlier - at about 3-4 months of age - and the babies need constant monitoring to determine when they are ready for the second surgery. Drew had his second surgery, the Bidirectional Glenn, performed when he was 7 months old.
The third and final stage, the Fontan, allows the rest of the blood coming back from the body to go to the lungs. There are two different ways to perform the Fontan: The Lateral Tunnel Fontan, the traditional approach, and the newer External Conduit Fontan. The Lateral Tunnel Fontan is usually performed at about 18 months - 3 years of age, and the External Conduit Fontan is usually performed at about 3-4 years of age.
The External Conduit Fontan uses an external conduit, or tube, that is placed just outside the heart. It is hoped that by using this conduit that the potential for arrhythmias will be greatly reduced in the future. However, this is a relatively new procedure and the outcomes will not be known for several years. It is usually done later than the Lateral Tunnel Fontan because the child has to be big enough to handle a conduit that can handle the blood flow as the child grows. |
