Stage 2 of the Norwood procedure is separation of the systemic and pulmonary circulation once pulmonary vascular resistance has fallen, by removing the aortopulmonary shunt followed by creation of a bidirectional SVC-pulmonary shunt, also known as a Glenn procedure.
12.
Inhaled nitric oxide vasodilates, decreasing pulmonary arterial pressure ( PAP ) and pulmonary vascular resistance ( PVR ) without affecting systemic artery pressure because it is rapidly inactivated by hemoglobin, and improves oxygenation by redistributing pulmonary blood flow to ventilated areas of lung.
13.
Several factors inhibit this process including increased cardiac output, hypocapnia, hypothermia, acidosis / alkalosis, increased pulmonary vascular resistance, inhaled anesthetics, calcium channel blockers, positive end-expiratory pressure ( PEEP ), high-frequency ventilation ( HFV ), isoproterenol, nitric oxide, and vasodilators.
14.
Since the right ventricle generates far lower pressures than the left ventricle ( approximately 20 mmHg versus around 120 mmHg, respectively, in the healthy individual ) but nonetheless generates cardiac output exactly equal to the left ventricle, this means that a small increase in pulmonary vascular resistance causes a large increase in amount of work the right ventricle must perform.
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