the hypoplastic left heart syndrome includes a spectrum of underdevelopment of the left-sided cardiac structures, characterized by aortic valvar atresia or severe stenosis with a small ascending aorta and hypoplasia of the left ventricle. without surgical treatment, practically all infants with this complex cardiac anomaly die within the first month of life. since norwood et al. reported successful surgical palliation in 1981, multi-staged reconstructive surgery, involving the norwood procedure as the first stage, followed by a bi-directional glenn anastomosis and subsequent completion of the fontan circulation, has become the established surgical treatment.