Extraatrial interatrial duct and reestablishment of aortopulmonary communication by enlarging the aortic arch. Experimental development of two surgical techniques for hypoplastic left heart syndrome palliation without extracorporeal circulation.

A new surgical procedure is presented for palliation of hypoplastic left heart syndrome. The first palliative technique consists of creation of an extraatrial interatrial duct and the second, reestablishment of the aortopulmonary communication by enlarging the aortic arch with a "conduit patch". Both procedures avoid having to clamp small systemic vessels and pulmonary veins and extracorporeal circulation is not needed. Extraatrial interatrial ducts were created in 10 dogs and the effectiveness of the procedure was evaluated. Reestablishment of the aorto-pulmonary communication and enlargement of the aortic arch was done in 7 specimens from patients with hypoplastic left heart syndrome who had died in the first hours of life and in 8 dogs. The surgical procedures, their advantages and the results obtained are described.