Norwood Procedure

The Norwood procedure is the first of three surgeries required to treat hypoplastic left heart syndrome (HLHS). Because the left side of the heart can’t be fixed, the series of HLHS surgeries rebuilds other parts of the heart to redirect the blood flow.

Hypoplastic left heart syndrome once was considered inoperable. Advances such as the three procedures currently used to treat the condition give more babies the chance to live full lives.

This first step in the series of surgeries is performed in the baby’s first or second week of life.

Cardiothoracic surgeons at Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, have three goals for the open-heart Norwood procedure:

  • Build a new aorta.
  • Direct blood from the right ventricle through the new aorta and on to the rest of the body.
  • Direct the right ventricle to pump blood to the lungs until the next surgery.

The board-certified and fellowship-trained cardiothoracic surgeons at Norton Children’s Heart Institute are equipped to perform the Norwood procedure — the most complicated of the three HLHS surgeries. Once your child goes home after a Norwood procedure, you will have a hotline directly to the team for support anytime, day or night.

Main Steps of the Norwood Procedure

  • Building a new, larger aorta. The bottom part of the pulmonary artery is joined with the baby’s weak, undeveloped aorta. This new aorta, or neoaorta, becomes the path for blood 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. A round tube (shunt) routes blood either from a large vessel off the aorta (with a Blalock-Taussig, or BT shunt) or directly from the right ventricle (with a Sano shunt) to the pulmonary artery.

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The care team will decide which shunt is best for the baby.

The shunt is a temporary fix. It helps the baby get blood to the lungs until the next surgery, during which the surgeons will create a more permanent solution.

  • Closing the patent ductus arteriosus. This opening typically closes on its own a day or two after birth. In children with HLHS, the opening must be kept open with medication so blood can flow to the rest of the body. Now that the right ventricle has taken over pumping blood to the body, the patent ductus arteriosus can be closed.
  • Widening the atrial septal defect. To make sure blood with oxygen gets back to the right ventricle, the atrial septal defect is made bigger.

Babies who have the Norwood procedure usually spend three to four weeks in the hospital to recover. They also get medicines to help the heart and improve blood flow. The physicians and staff at Norton Children’s Hospital provide around-the-clock care and monitoring.

While the baby is recovering, 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. If you are caring for a baby who has had this procedure, stay in close contact with the care team and keep an eye on:

  • Weight gain and growth
  • Oxygen levels

Call the care team right away if the baby:

  • Has difficulty feeding
  • Has difficulty breathing
  • Seems very irritable
  • Just doesn’t seem quite right
  • Has lower oxygen levels than usual

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

Why Choose Norton Children’s Heart Institute

The Adult Congenital Heart Association has recognized Norton Children's Heart Institute for its expertise treating adult congenital heart disease.

  • Norton Children’s Hospital has been a pioneer in pediatric cardiothoracic surgery, performing Kentucky’s first pediatric heart transplant in 1986 and becoming the second site in the United States to perform an infant heart transplant.
  • The American Board of Thoracic Surgery has certified our cardiothoracic surgeons in congenital heart surgery.
  • The Adult Congenital Heart Association has accredited Norton Children’s Heart Institute’s Adult Congenital Heart Program as the only comprehensive care center in Kentucky and Indiana treating adults born with a heart defect.
  • More than 5,000 children a year visit Norton Children’s Heart Institute for advanced heart care.
  • Norton Children’s Heart Institute has offices across Kentucky and Southern Indiana to bring quality pediatric heart care closer to home.
  • The Jennifer Lawrence Cardiac Intensive Care Unit (CICU) at Norton Children’s Hospital is the largest dedicated CICU in Kentucky, equipped with 17 private rooms and the newest technology available for heart care.
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An illustration shows hypoplastic left heart syndrome

During Norwood Procedure

An illustration shows the Norwood Procedure

After Norwood Procedure

An illustration of bloodflow after the Norwood Procedure
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