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The Sano shunt is a surgical procedure used primarily in the management of congenital heart defects, particularly in patients with single ventricle physiology such as those with hypoplastic left heart syndrome. This surgical intervention is designed to improve blood flow to the lungs while allowing for the systemic circulation to function effectively. The Sano shunt involves connecting the right ventricle directly to the pulmonary arteries using a graft, typically made of a synthetic material. This approach provides a means of redirecting blood flow to the lungs, ensuring adequate oxygenation of the blood, while minimizing the pressure overload on the heart. The Sano shunt is usually performed in a staged approach, often as a part of a comprehensive management plan that may also include other surgeries like the Norwood procedure and the Fontan operation. Each of these surgeries is strategically timed and sequenced to support the developing child, as many of these patients will require multiple interventions throughout their early years. One of the primary advantages of the Sano shunt over other similar procedures, like the Blalock-Taussig shunt, is its ability to provide more stable hemodynamics by using the right ventricle as the primary source of flow to the pulmonary arteries, reducing the risk of complications such as pulmonary artery stenosis and allowing for better oxygen saturations over the lifespan of the patient. This procedure is usually performed during infancy, often before six months of age, and is crucial in the multi-staged management of complex heart defects where palliative measures must be provided. Postoperatively, patients will require close monitoring for complications, including potential graft obstruction or issues related to the function of the right ventricle. Additionally, careful follow-up is essential to assess growth, development, and cardiac function over time. As patients age, they may eventually require further surgical interventions, particularly transitioning to a Fontan circulation in later stages, which further reroutes blood flow to optimize systemic oxygen delivery and manage the unique physiology of single ventricle function. Overall, while the Sano shunt serves as a critical bridge in the treatment of complex congenital heart disease, its success heavily relies on a multidisciplinary approach involving pediatric cardiologists, cardiothoracic surgeons, and specialized nursing care to ensure optimal outcomes for affected children as they progress through their treatment journey. Although it presents challenges and risks, many children who undergo the Sano shunt procedure go on to lead active, fulfilling lives, underscoring the importance of ongoing advancements in pediatric cardiac surgery and intervention strategies.