Norwood on the beating heart: two cases with continuous cerebral and myocardial perfusion

The Norwood procedure is routinely performed in circulatory arrest. The degree of neurological injury from circulatory arrest is directly related to the duration of arrest time. We report a technique of selective cerebral and myocardial perfusion with the aim to reduce ischemic damage to brain and heart. We performed a modified Norwood procedure on two neonates (5 and 29 days old) with single ventricle physiology, coarctation, and hypoplastic aortic arch. In both cases the ascending aorta was of adequate size for arterial cannulation. We cannulated the ascending aorta and clamped the aortic arch distally to the innominate artery.Aortic arch repair was performed in moderate hypothermia with the heart beating, while both the brain and the heart were selectively perfused. The time period of selective cerebral and myocardial perfusion was 56 and 61min, respectively. Both children recovered uneventfully without neurological or myocardial complications. Follow up time was 5 months. The Norwood procedure can successfully be performed without total circulatory arrest, but with protection of both brain and heart by continuous, selective perfusion.