Surgical and Interventional Palliation, Patient Care, and Safety
Palliative pathways
Staged single-ventricle palliation typically begins with the Norwood operation, which creates a neo-aorta, performs an atrial septectomy, and provides pulmonary blood flow through a Blalock-Taussig shunt or a right ventricle-to-pulmonary artery conduit (Sano). The superior cavopulmonary connection (Glenn) follows at about 3–6 months, and the Fontan completion at about 2–4 years. Other repairs include arterial switch for transposition, total anomalous pulmonary venous connection repair, coarctation repair, patent ductus arteriosus ligation, and hybrid procedures. Expected oxygen saturations differ by stage: a shunt-dependent patient often runs about 75–85%, a Glenn patient about 75–85%, and a Fontan patient about 95%. A saturation near 100% after a Glenn deserves evaluation for additional pulmonary blood flow or other causes.
Patient care and safety
Sedation must be titrated to the child's hemodynamic status, especially in shunt-dependent or single-ventricle patients. Monitor oxygenation, blood pressure, and perfusion. Follow infection-control and probe-disinfection protocols. Apply ALARA principles: minimize acoustic power and exposure time, and use the thermal and mechanical indices. Keep the child warm, minimize agitation, and recognize post-operative junctional ectopic tachycardia and low cardiac output.
Traps
Do not expect normal saturations after a Glenn. Do not mistake a expected shunt murmur for a new defect. Do not dismiss hypotension after coarctation repair.
Rule of thumb
Saturations follow the stage: shunt or Glenn about 75–85%, Fontan about 95%.