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CMAJ
CMAJ - February 9, 1999JAMC - le 9 février

Norwood reconstruction

CMAJ 1999;160:313

See also:
The article about the Winnipeg inquest into the deaths of 12 young heart patients1 [full text] includes the following editorial statement: "[Norwood reconstruction], used to treat infants with hypoplastic left-heart syndrome, is considered a palliative procedure, since transplants are considered the treatment of choice for this condition. The operation has a very high mortality rate."

This statement is inaccurate. There is a paucity of suitable donors in Canada, neonatal heart transplantation is available in only a few centres, and excellent results have been achieved for the Norwood procedure in this country, so the treatment of choice for most variants of hypoplastic left-heart syndrome is in fact the Norwood procedure. The procedure is done at the Hospital for Sick Children in Toronto, the University of Alberta Hospitals in Edmonton, British Columbia's Children's Hospital in Vancouver and the Montreal Children's Hospital.

The operation is complex, and the mortality rate, which is substantial, varies from one centre to another. One might certainly question why an inexperienced surgeon would attempt such a procedure. One might also question the source of the referral. Surgeons do not recruit patients directly, but receive referrals from cardiologists.

Robert J. Adderley, MD
Pediatric Intensive Care Unit
British Columbia's Children's Hospital
Vancouver, BC

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Reference
  1. Sibbald B. Twelve deaths in Winnipeg: judge must ponder 48 000 pages of inquest testimony. CMAJ 1998;159(10):1285-7.