The Norwood Procedure

What to expect

What happens during the Norwood Procedure?

The Norwood is a surgical procedure that is performed by one of our skilled congenital heart surgeons. It typically takes several hours because of the complexity of the procedure.

Prior to the procedure, you will meet with a cardiologist and a congenital heart surgeon to review the steps of the procedure, what to expect after the procedure, and have all your questions answered. A surgical date will be set for your child shortly after birth.

In the days leading up to surgery, you will be introduced to our expert team of anesthesiologists who will take care of your child in the operating room (OR), which includes putting them gently to sleep. At Riley Children’s, we have an anesthesia team dedicated only to caring for children with heart problems, so you know your child will be receiving the most specialized care.

After your baby is comfortably asleep, the congenital heart surgeon works meticulously to gain access to the heart by cutting through the skin and breast bone. Once the heart is accessed, they will place specialized tubes in the blood vessels around the heart to place your child on a heart-lung machine.

The heart-lung machine, also known as a cardiopulmonary bypass machine, does the job of the heart and lungs by circulating oxygenated blood to the body and the brain while the surgeon completes the operation. During the Norwood Procedure, the heart surgeon performs the following steps:

• To begin, a large hole is created in the top chambers of the heart. This allows for proper mixing of blood and an unrestricted path for the blood to reach the main pumping chamber.
• The pulmonary artery is the vessel that brings deoxygenated blood, while the aorta is the artery that typically provides oxygenated blood to the body. In HLHS, the aorta is very small and unable to effectively provide enough blood to the body. For this reason, it is enlarged by attaching it side-by-side to the larger pulmonary artery. Once the blood vessels are joined, they become one vessel providing blood flow from the single ventricle to the body.
• With the pulmonary artery now helping to provide blood flow to the body, the surgeon needs to provide a route for blood to flow to the lungs. This can be achieved by either a Blalock-Taussig-Thomas (BTT) shunt or a Sano shunt. The BTT shunt is a small tube that connects an artery arising from the aorta to the pulmonary artery. A Sano shunt is a slightly larger tube that connects the right ventricle to the pulmonary artery.
• The entirety of the aortic arch is then examined and enlarged. This ensures no obstruction to blood flow throughout the body. Once that is performed, your child is slowly taken off the heart-lung bypass machine and the procedure is complete.

Recovery

After the operation, your child will be monitored closely in our Cardiovascular Intensive Care Unit or CVICU, where highly- trained cardiac intensive care doctors, cardiologists and skilled cardiac nurses closely monitor them to ensure a smooth recovery. Following surgery, your baby will remain in the CVICU for close monitoring, including breathing support, medications to ensure comfort and support heart function, and around-the-clock care.  Recovery time varies, but most babies stay in the hospital for several weeks after the operation. During this time, you will be allowed to stay close your baby in their private room equipped with a sleeping space and a private bathroom.  You may participate in rounds which are performed daily and ask any questions at any time.

What happens after recovery?

When your baby has recovered and it is almost time to go home, we may transition them to our cardiac step-down unit, where we continue to work on feeding, growth and development. We ensure that you are fully comfortable with caring for them prior to discharge.  Even after you leave the hospital, we provide an interstage home monitoring program so that you never feel alone. This program was developed to allow accessible and ongoing monitoring of your child's vitals and growth while they remain in the comfort of their home.  This way, we are able to detect any noticeable concerns and address them quickly. This program continues until your child goes through their second stage surgery, known as the Hemi-Fontan or Glenn, which is typically completed around 6-9 months of age.

Your child will also continue to have close follow-up in the outpatient clinic setting to ensure they are progressing well until the next procedure. This will include vital checks, growth monitoring as well as echocardiograms (ultrasounds) of their heart. You will be provided with the number for our on-call staff cardiologists who are available to answer your questions 24 hours a day, 7 days a week. At Riley Children’s, your child’s recovery, ongoing care and ultimate outcome are what matter most to us.

Key Points to Remember

• The Norwood Procedure is the first stage in a series of three open heart surgeries utilized to palliate specific forms of single ventricle congenital heart defects, such as Hypoplastic Left Heart Syndrome or HLHS.
• The Norwood is typically performed in the first few days of life, so your baby will stay in the hospital until the surgery is performed.
• Your child will also continue to have close follow-up in the outpatient clinic setting to ensure they are progressing well until the next procedure.