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Norwood Procedure

Hypoplastic left heart syndrome (HLHS) is a severe congenital heart defect (present at birth) in which the left side of the heart is underdeveloped. In a normal heart, the heart's left side has the job of pumping oxygenated blood into the aorta (large artery that carries blood to the body). In a child with HLHS, there are several problems: the mitral valve is too small or completely closed; the left ventricle is very small; and the aortic valve is too small or completely closed. This results in a situation where the left side of the heart is completely unable to support the circulation needed by the body's organs. Without treatment, HLHS is fatal, often within the first hours or days of life.

To address HLHS, three types of open-heart surgeries (involves dividing the breast bone / general anesthesia) must take place. These must follow a specific order: Norwood procedure (within several days of birth), Glenn Operation (within six months of birth), and the Fontan procedure (approximately at 2 to 4 years of age).

What to expect before the procedure

Before the procedure, your doctor may perform a variety of tests, including:

Diagnostic tests and procedures

What to expect during the procedure

This procedure usually takes 5 to 6 hours, but preparation and recovery may add several hours. The procedure is usually performed in the cardiothoracic operating room (OR). In general, during this procedure:

  • Your baby will be sedated, then the doctor will insert a breathing tube through your baby’s throat into their lungs and connect it to a ventilator. This will breathe for your baby during surgery.
  • Your doctor will administer general anesthesia (will make your baby feel sleepy).
  • The procedure begins when your doctor exposes your baby’s heart by dividing the breastbone (sternum) in half. Your doctor then spreads both halves to gain access to your baby’s heart (open-heart surgery).
  • For this type of surgery, the heart must be still. Prior to doing so, your doctor will place tubes into your baby’s heart so that blood can be pumped through your baby’s body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
  • Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.
  • When the heart has been stopped, your doctor will start with the procedure. The goals of the Norwood operation are to make sure blood is reaching the lungs and to better control the blood flow to prevent damage to the lungs and heart.
  • First, the blood vessel leaving the right of the heart (pulmonary artery) is divided. The far end (end closest to the lungs) is sewn shut. The near end (closest to the heart is sewn into the aorta). A patch is sewn in this area to make the “new aorta” bigger and stronger. Now, all the blood leaving the heart goes from the right side of the heart through the pulmonary valve and out the body through the new aorta.
  • A hollow tube (shunt) that connects the new aorta to the pulmonary artery is sewn in place. The shunt lets some of the blood pumped to the body go to the lungs.
  • The septal wall between the heart's two upper chambers (atria) is removed. This allows red blood coming back from the lungs to flow from the left upper chamber to the right upper chamber. The blood then goes to the right lower chamber and out to the body.
  • After the procedure is completed, the doctor will closely check to make sure everything is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your baby’s heart.
  • Once the procedure is complete, the machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use or sutures or surgical staples.

What to expect after the procedure

After the procedure, your baby will be taken to the cardiothoracic intensive recovery unit (CTICU) for a few days. Your baby will also spend several days in the recovery unit. During this time the cardiac team will:

General guidelines

  • Make sure your baby’s vital signs, such as heart rate and breathing, are watched.
  • Make sure your baby feels no pain by giving pain medication
  • Make sure to look after your newborn’s medications
  • Manage the tubes (drains) that were placed in your baby’s chest during surgery
  • Take care of the chest wound (sternal incision) and any other incision sites
  • Make sure that your newborn is able to feed well by mouth
  • Will give you instructions to follow during your baby’s recovery


Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
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Children's Hospital of New Jersey at Newark Beth Israel Medical Center
201 Lyons Avenue at Osborne Terrace
Newark, NJ 07112
(973) 926-7000
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