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Norwood Procedure


Why Does a Baby Need the Norwood Procedure?

In hypoplastic left heart syndrome (HLHS), the left side of the heart doesn't grow as it should, making it smaller and weaker than normal. To survive, babies who are born with this rare heart defect need a series of three surgeries.

The left side of the heart can't be fixed. Instead, the surgeries rebuild parts of the heart and redirect the way blood flows around the body.

They are (in order):

  1. the Norwood procedure
  2. the Glenn procedure
  3. the Fontan procedure

Babies usually have the first surgery when they're about 2 weeks old.

What Is the Norwood Procedure?

The Norwood procedure is a type of open-heart surgery. The goal is to:

  • Build a new aorta (the main path from the heart to the body).
  • Make the right ventricle pump blood to the body through the new aorta.
  • Make the right ventricle pump blood to the lungs through a new path to the pulmonary artery (the main path from the heart to the lungs).

What Happens During the Norwood Procedure?

The main steps of the Norwood procedure are:

  • Building a new, larger aorta. The bottom part of the pulmonary artery is joined with the baby's weak, undeveloped aorta. This new aorta is stronger and is now the path from the right ventricle to the body.

Because the bottom of the pulmonary artery is used to make the new aorta, a new path from the heart to the lungs has to be built by:

  • Using a shunt to change the path of blood flow. In this case, the shunt creates the path for blood to go from the right ventricle to the lungs by going through the top of the pulmonary artery.

The shunt is a temporary fix. It helps the baby get oxygen until the next surgery, which creates a more permanent solution. Two kinds of shunts can be used. Your child's care team will decide which is best for your baby.

  • Closing the patent ductus arteriosus (PDA). Up until now, the PDA was the only way blood could flow to the body. Now that the right ventricle is pumping to the body, the PDA isn't needed anymore.

What Happens After the Norwood Procedure?

Babies who have the Norwood procedure usually spend 3 to 4 weeks in the hospital to recover. During this time, they get-around-the-clock care and monitoring. They also get medicines to help the heart and improve blood flow.

During this time, the care team teaches parents how to care for their baby at home. Babies usually can go home when they are feeding well, growing well, and gaining weight.

At home, the baby needs to be watched closely. Parents should keep an eye on:

  • growth
  • weight gain
  • oxygen levels

Parents will be in close contact with the care team, and should call right away if their baby:

  • has feeding problems
  • has breathing problems
  • seems very irritable
  • just doesn't seem quite right

A baby who gains enough weight and is growing well is ready for the next procedure.

What's the Next Procedure?

The second surgery is called the Glenn procedure. It's usually done when a baby is 4 to 6 months old.

Reviewed by: Kate M. Cronan, MD
Date reviewed: July 2018

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