the abdominal wall and the left ventricle outflow track has to be parallel to the intended cannula course in order for the wire to be blindly directed at the aortic valve. An 11.5 cm long, 19-gauge cannula and stylet needle passes through the mother's abdomen, uterine wall, and fetal chest wall into the left ventricle of the fetus. Then a 0.014 inch guide wire is passed across the stenosis aortic valve, where a balloon is inflated to stretch the aortic annulus. Once born, critical or severe aortic stenosis is often treated through a less invasive catherization procedure knows as aortic valvuloplasty. Other options for newborns involve open heart surgery. Potential open heart surgeries may include aortic valve repair or the Ross procedure. If the fetal aortic stenosis is critical it may lead to hypoplastic left heart syndrome. Hypoplastic Left Heart Syndrome (HLHS) it is treated with the Norwood procedure. This typically consists of three surgeries creating and removing shunts. The atrial septum is removed, the aortic arch is reconstructed to remove any hypoplasia, and then the main pulmonary artery is connected into this reconstructed arch, resulting in the right ventricle ejecting directly into systemic circulation. the end result is the right ventricle pumping blood to both the body and to the lungs. An alternative to the Norwood procedure is known as the hybrid procedure, was developed in 2008. In the hybrid procedure, bilateral pulmonary artery bands are positioned to limit pulmonary flow while, at the same time, placing a stent in the ductus arteriosus to hold it open. This maintains the connection between the aorta and the systemic circulation. A balloon atrial septostomy is also done. This ensures that there is enough of a connection between the two atria of the heart to provide open blood flow and mixing of oxygen rich and poor blood This procedure spares the baby from undergoing open heart surgery until they are older. They typically come back at 4–6 months of age when they are stronger for the open heart surgery. References Respiratory and cardiovascular disorders specific to the perinatal period