Advancements in prenatal diagnosis and management of hypoplastic left heart syndrome: A multidisciplinary approach and future directions

Figure 6 Interventional strategies for hypoplastic left heart syndrome across the lifespan[87]. Adapted under authorization from Wald et al[87]. Citation: Wald RM, Mertens LL. Hypoplastic Left Heart Syndrome Across the Lifespan: Clinical Considerations for Care of the Fetus, Child, and Adult. Can J Cardiol 2022; 38: 930-945. Citation: Copyright© 2025 published by Elsevier Inc. This figure outlines the staged palliative surgical procedures for hypoplastic left heart syndrome, culminating in Fontan circulation. Stage one (Norwood procedure) involves creating systemic circulation using the right ventricle, a pulmonary homograft, and an atrial septectomy. Stage two (bidirectional Glenn shunt) and stage three (Fontan procedure) progressively redirect venous return directly to pulmonary circulation. Hybrid approaches provide less invasive alternatives to the Norwood procedure, employing ductal arteriosus shunts, pulmonary artery bands, and atrial septostomy. The inter-stage period involves continuous monitoring before subsequent surgical stages. HLHS: Hypoplastic left heart syndrome; BCPC: Bidirectional cavopulmonary connection; TCPC: Total cavopulmonary connection.