{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:13:52Z","timestamp":1792725232233,"version":"4.5.0"},"reference-count":21,"publisher":"Cambridge University Press (CUP)","issue":"S1","license":[{"start":{"date-parts":[[2006,1,10]],"date-time":"2006-01-10T00:00:00Z","timestamp":1136851200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiol Young"],"published-print":{"date-parts":[[2006,2]]},"abstract":"<jats:p>\n                    For children with hypoplastic left heart syndrome, contemporary management over three stages includes a window of high risk for sudden death between the initial stage of palliation, the Norwood operation itself, and the second stage, creation of the bidirectional superior cavopulmonary connection. The risk is highest at a time when patients have been discharged from the hospital to grow and prepare for the second stage,\n                    <jats:sup>1<\/jats:sup>\n                    <jats:sup>\u2013<\/jats:sup>\n                    <jats:sup>4<\/jats:sup>\n                    and has persisted despite the remarkable improvements in immediate postoperative and hospital survival after the initial surgery.\n                    <jats:sup>5<\/jats:sup>\n                    <jats:sup>,<\/jats:sup>\n                    <jats:sup>6<\/jats:sup>\n                    Potential contributing factors to the increased vulnerability to sudden death between the stages include the limited circulatory reserve inherent in the parallel circulations supported by a functionally univentricular heart, the reliance on a prosthetic shunt which is susceptible to thrombosis, and congenital or acquired anatomical cardiovascular abnormalities such as aortic atresia, residual obstruction in the aortic arch, tricuspid valvar insufficiency, or right ventricular dysfunction.\n                    <jats:sup>7<\/jats:sup>\n                    <jats:sup>\u2013<\/jats:sup>\n                    <jats:sup>12<\/jats:sup>\n                  <\/jats:p>","DOI":"10.1017\/s1047951105002349","type":"journal-article","created":{"date-parts":[[2006,1,10]],"date-time":"2006-01-10T06:54:48Z","timestamp":1136876088000},"page":"61-66","source":"Crossref","is-referenced-by-count":79,"title":["Optimal timing of the second stage of palliation for hypoplastic left heart syndrome facilitated through home monitoring, and the results of early cavopulmonary anastomosis"],"prefix":"10.1017","volume":"16","author":[{"given":"Nancy S.","family":"Ghanayem","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James S.","family":"Tweddell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George M.","family":"Hoffman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Mussatto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D. B.","family":"Jaquiss","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2006,1,10]]},"reference":[{"key":"S1047951105002349_ref003","doi-asserted-by":"crossref","unstructured":"Ghanayem NA , Hoffman GM , Mussatto KA , et al. Home surveillance program prevents interstage mortality after the Norwood procedure. J Thorac Cardiovasc Surg 2003; 126: 1367\u20131377.","DOI":"10.1016\/S0022-5223(03)00071-0"},{"key":"S1047951105002349_ref009","doi-asserted-by":"crossref","unstructured":"Mahle WT , Spray TL , Wernovsky G , Gaynor JW , Clark III BJ . Survival after reconstructive surgery for hypoplastic left heart syndrome: a 15-year experience from a single institution. Circulation 2000; 102: III-136\u2013III-141.","DOI":"10.1161\/01.CIR.102.suppl_3.III-136"},{"key":"S1047951105002349_ref016","unstructured":"Tsao S , Pigula F , Siewers R , Maihle T , Rebovich , Ettedgui J . Viral illness may be detrimental to patients with hypoplastic left heart syndrome post stage 1 Norwood procedure. Available online at http:\/\/www.mwpcsociety.org\/pages\/archiveindex.html. Accessed March 1, 2002."},{"key":"S1047951105002349_ref018","unstructured":"Chang AC , Hanley FL , Wernovsky G , et al. Early bidirectional cavopulmonary shunt in young infants. Postoperative course and early results. Circulation 1993; 88 (Pt 2): II149\u2013II158."},{"key":"S1047951105002349_ref004","doi-asserted-by":"crossref","unstructured":"Mahle WT , Spray TL , Gaynor JW , Clark III BJ . Unexpected death after reconstructive surgery for hypoplastic left heart syndrome. Ann Thorac Surg 2001; 71: 61\u201365.","DOI":"10.1016\/S0003-4975(00)02324-9"},{"key":"S1047951105002349_ref013","doi-asserted-by":"crossref","unstructured":"Tweddell JS , Hoffman GM , Fedderly RT , et al. Phenoxybenzamine improves systemic oxygen delivery after the Norwood procedure. 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Ann Thorac Surg 2002; 73: 331\u2013340.","DOI":"10.1016\/S0003-4975(01)02720-5"},{"key":"S1047951105002349_ref014","doi-asserted-by":"crossref","unstructured":"Tweddell JS , Hoffman GM , Mussatto KA , et al. Improved survival of patients undergoing palliation of hypoplastic left heart syndrome: lessons learned from 115 consecutive patients. Circulation 2002; 106: I82\u2013I89.","DOI":"10.1016\/S1062-1458(02)01082-6"},{"key":"S1047951105002349_ref010","doi-asserted-by":"crossref","unstructured":"Poirier NC , Drummond-Webb JJ , Hisamochi K , Imamura M , Harrison AM , Mee RB . Modified Norwood procedure with a high-flow cardiopulmonary bypass strategy results in low mortality without late arch obstruction. J Thorac Cardiovasc Surg 2000; 120: 875\u2013884.","DOI":"10.1067\/mtc.2000.109540"},{"key":"S1047951105002349_ref001","doi-asserted-by":"crossref","unstructured":"Azakie A , Merklinger SL , McCrindle BW , et al. Evolving strategies and improving outcomes of the modified Norwood procedure: a 10-year single institution experience. Ann Thorac Surg 2001; 72: 1349\u20131353.","DOI":"10.1016\/S0003-4975(01)02795-3"},{"key":"S1047951105002349_ref021","doi-asserted-by":"crossref","unstructured":"Jaquiss RDB , Ghanayem NS , Hoffman GM , et al. Early cavopulmonary anastomosis in very young infants after the Norwood procedure: impact on oxygenation, resource utilization, and mortality. J Thorac Cardiovasc Surg 2004; 127: 982\u2013988; discussion 988\u2013999.","DOI":"10.1016\/j.jtcvs.2003.10.035"},{"key":"S1047951105002349_ref007","doi-asserted-by":"crossref","unstructured":"Jonas RA . Intermediate procedures after first-stage Norwood operation facilitate subsequent repair. Ann Thorac Surg 1991; 52: 696\u2013700.","DOI":"10.1016\/0003-4975(91)90980-5"},{"key":"S1047951105002349_ref008","doi-asserted-by":"crossref","unstructured":"Bartram U , Grunenfelder J , Van Praagh R . Causes of death after the modified Norwood procedure: a study of 122 postmortem cases. Ann Thorac Surg 1997; 64: 1795\u20131802.","DOI":"10.1016\/S0003-4975(97)01041-2"},{"key":"S1047951105002349_ref020","unstructured":"Bradley SM , Mosca RS , Hennein HA , Crowley DC , Kulik TJ , Bove EL . Bidirectional superior cavopulmonary connection in young infants. Circulation 1996; 94: II5\u2013II11."},{"key":"S1047951105002349_ref015","doi-asserted-by":"crossref","unstructured":"Pizarro C , Mroczek T , Malec M , Norwood WI . Right ventricle to pulmonary artery conduit reduces interim mortality after stage 1 palliation for hypoplastic left heart syndrome. Ann Thorac Surg 2004; 78: 1959\u20131964.","DOI":"10.1016\/j.athoracsur.2004.06.020"},{"key":"S1047951105002349_ref006","doi-asserted-by":"crossref","unstructured":"Tabbutt S , Dominguez TE , Ravishankar C , et al. Contemporary comparison of outcomes following use of the right ventricular to pulmonary artery conduit vs. the modified Blalock Taussig Shunt as part of the modified Norwood procedure. Ann Thorac Surg 2005; In press.","DOI":"10.1016\/j.athoracsur.2005.04.046"},{"key":"S1047951105002349_ref012","doi-asserted-by":"crossref","unstructured":"Forbess JM , Cook N , Roth SJ , Serraf A , Mayer Jr JE , Jonas RA . Ten-year institutional experience with palliative surgery for hypoplastic left heart syndrome: risk factors related to stage I mortality. Circulation 1995; 92: II-262\u2013II-266.","DOI":"10.1161\/01.CIR.92.9.262"},{"key":"S1047951105002349_ref017","doi-asserted-by":"crossref","unstructured":"Fogel MA , Rychik J , Vetter J , Donofrio MT , Jacobs M . Effect of volume unloading on coronary flow dynamics in patients with aortic atresia. 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