1.

Jawaban SANO VS BT SHUNT ( stephanie)

thank you for your question,dr. rasyid. According to the journal from Department of Paediatric
Cardiothoracic Surgery, Great Ormond Street Hospital, London WC1N 3JH, UK 2010 Apr;10(4):620-3. Epub
2010 Jan 6, with title “In hypoplastic left heart patients is Sano shunt compared with modified Blalock-
Taussig shunt associated with deleterious effects on ventricular performance?”16

Compared with the mBT shunt, the RV-PA conduit provides a more stable haemodynamic state in
the immediate postoperative period and is reported to be associated with lower interstage mortality. None
of the echocardiographic or clinical outcome studies showed poor ventricular performance after
ventriculotomy of the systemic RV for construction of Sano shunt. So We conclude that the current
available evidence, although weak, does not show any adverse effects of ventriculotomy on ventricular
performance in patients with Sano shunt in the short- and medium-term.16

2. Hybrid procedure vs norwood procedure, some journal said that hybrid was superior preference
Jawaban ( adrin)
thank you for your question ,dr adrin. According to the british medical journal about Impact of
Norwood versus hybrid palliation on cardiac size and function in hypoplastic left heart syndrome
“Patients after Norwood and hybrid procedures had equivalent indices of RV size, and systolic and
diastolic function throughout all stages of palliation. Small differences in individual Right Ventricle
and Tricuspid valve indices are likely to be explained by differences in physiology or surgical timing
rather than by intrinsic differences in myocardial and valve function.”

So which one is better? It will depends on the resources, equipment, infrastructure, and even
political/economical administrative support, which go well beyond the mere neonatal period of any given
patient.

1. Post operative norwood apa yang harus diperhatikan atau kenapa norwood procedure sering
gagal? ( septi)

thank you for your question,dr. septi. The success of norwood procedure is not only determined by the
success in the operating table, but it will depends on the Early postoperative management

Early postoperative management involves balancing Qp:Qs to be as close to 1:1 as possible; desaturated
patients with high PVR may require higher FiO2 and inhaled nitric oxide, or possibly enlargement of the
BT shunt (263). Most patients have the problem of PVR that is relatively low, and decreasing FiO2 and
minute ventilation to increase PaCO2 will elevate PVR and help achieve balance, and in severe cases the
shunt may require downsizing. Inotropic support with dopamine, epinephrine, or milrinone is usually
required, and the sternum is often left open for 24 to 72 hours. Bleeding may be significant and treatment
with platelets, cryoprecipitate, red blood cells, and fresh frozen plasma is often necessary. ECMO support
is at times necessary, either for low cardiac output or cardiac arrest.
 3. What about the mortality rate of hybrid procedure and when we use hybrid procedure(septi)

Jawaban : thank you for your question, the mortality after the hybrid procedure has been lower than
after the surgical approach in these high-risk patients. In infants with low birth weight, survival
after the hybrid procedure was 66%
The hybrid approach is a satisfactory alternative in the management of high-risk infants with
HLHS and its variants. Although the results are encouraging, further studies are required to
identify risk factors. An important advantage of this approach is in infants with aortic stenosis and
borderline LV dimensions in whom the left ventricle is given time to grow enough to allow
biventricular repair.
4. Pertanyaan tentang acidosis repiratorik vs metabolic( Charles)
thank you for your question,dr. Charles. yeah, I agree with your statement that usually Hypoplastic left
hert syndrome patients will have metabolic acidosis due to closing of PDA and causing cardiogenic shock
symptoms, but in this patient has not happened yet, because the size of PDA (7mm), enough to meet the
required blood flow to the body