Adjustable tourniquet to manipulate pulmonary blood flow after Norwood operations

Background. Survival after first-stage palliative Norwood operations for single ventricle with systemic outflow obstruction is mainly dependent on a balanced ratio of pulmonary blood flow to systemic blood flow. Here we report the clinical results using a modified technique that allows a controlled systemic-to-pulmonary shunt flow to prevent pulmonary overcirculation. Methods. From 1995 to 1998, of 26 infants undergoing first-stage palliative Norwood operations, 7 had placement of an adjustable tourniquet around a modified right Blalock-Taussig shunt. Results. Hospital survival was 20 of 26 patients (77%). All 7 patients in whom snaring of the shunt was indicated survived. Two patients underwent repeated adjustment, in 5 patients the tourniquet could be removed during delayed sternal closure, and 2 patients were discharged with the shunt partially snared. Conclusions. The snare-controlled systemic-to-pulmonary shunt allows improved hemodynamic stability after reconstructive surgery for hypoplastic left heart syndrome or other similar complex cardiac defects by reducing the risk of pulmonary overcirculation. It is simple and rapidly executed. The option of graded banding of the shunt depending on the hemodynamic situation increases flexibility and safety after cardiopulmonary bypass or at any time in the postoperative period.