A novel modification for the Sano conduit during stage I Norwood palliation for hypoplastic left heart syndrome: towards a more anatomical and physiologic connection.

We present a 3.7-kg neonate with a foetal diagnosis of hypoplastic left heart syndrome who underwent stage I Norwood palliation using two technical modifications. We reconstructed the aortic arch and the aorto-pulmonary connection by following the Birmingham technique. The source of pulmonary blood flow was provided via a right ventricular-to-pulmonary artery shunt (Sano). A novel modification to the Sano conduit is demonstrated that we believe is more anatomical and physiologic. The composite Sano conduit was constructed using a 5-mm externally reinforced polytetrafluoroethylene graft connected to a 7-mm aortic homograft valve. The homograft valve was placed at the right ventricular end of the Sano conduit. We believe this design mimics a more normal anatomical right ventricular-to-pulmonary arterial connection and will help preserve the single ventricle function due to the lack of free pulmonary regurgitation.