(Objective)One of the technical points of Norwood Procedure is how to reconstruct the non-obstructed pathway from RV to descending aorta. We have reconstructed Neo-aorta without patch material in most of the patients of HLHS using cerebral perfusion since 1998, although we have modified our technique during 10 year period. We retrospectively reviewed late outcome of arch reconstruction.

(Patients and Methods)
Since 1998, we have performed 71 modified Norwood procedure using arch reconstruction without patch materials in 63 patients and with small pericardial patch in 9 patients. No homograft was used. During 10 year periods, 2 technical modifications in arch reconstruction were adopted. One was proximal arch plasty (Aortic arch and ascending aorta just opposite site of innominate artery were sutured inferiory to extend the width of aortic arch and shortened the neo-aortic suture line). Another was distal arch plasty(application of Brawn’s modification).
(Results)Proximal arch plasty was applied in 21 patients and distal arch plasty was applied in 40 patients. With a mean follow up of 64 months, re-CoA was found to have in 10 patients(16%) Pressure gradient across the re-CoA was 5-23mmHg with a mean of 15mmHg.. Re-CoA was found in 1 patient out of 9 patch material group(11%) and 9 patients with 62 non patch group(14%) All re-CoA was balloon dilated successfully except one who required surgical intervention.
(Conclusion)Arch reconstruction was possible without patch material in most of the patients.Most of the re-CoA was repaired by balloon dilation.