The bilateral pulmonary artery banding for hypoplastic left heart syndrome with a diminutive ascending aorta.

A one-day-old neonate who was diagnosed with hypoplastic left heart syndrome (HLHS), aortic atresia, with a diminutive ascending aorta, and mitral atresia, was referred to us for cardiogenic shock because of excessive pulmonary blood flow. The patient underwent bilateral pulmonary artery banding (bPAB). After bPAB, the patient's hemodynamics were still unstable because of coronary malperfusion, to proceed to undergo Norwood procedure at the age of 3 days. In this case, the stenosis of the ascending aorta, just proximal to the innominate artery caused coronary ischemia. The precise evaluation of the ascending aorta is necessary to perform the bPAB for HLHS with diminutive ascending aorta. If there is a sign of stenosis of the ascending aorta, the Norwood procedure should be performed as the first stage palliation, even for high-risk HLHS patients.