What does the surgical palliation for HLHS typically involve?

The surgical palliation for hypoplastic left heart syndrome (HLHS) typically involves a three-stage approach. This method is designed to gradually redirect blood flow and improve hemodynamic stability in infants with this complex congenital heart defect.

The three stages commonly consist of the Norwood procedure, which is executed shortly after birth to establish systemic blood flow; the Glenn procedure, which is performed at around 4 to 6 months of age to reduce the workload on the heart by connecting the superior vena cava directly to the pulmonary artery; and finally, the Fontan procedure, usually done by 2 to 4 years of age to complete the palliation by connecting the inferior vena cava to the pulmonary artery, allowing for single ventricle circulation.

This staged approach is crucial because it allows for better management of the child's physiological status over time. It prepares the body for further surgical measures and supports growth, development, and increased physiological demands as the child matures.

While heart transplant is a potential solution for end-stage heart failure, it is not the typical surgical palliation method applied to HLHS initially. Immediate arterial switch repair is specifically indicated for transposition of the great arteries rather than HLHS. Single-stage repairs are generally not applicable given the complexities of HLHS