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 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.

The 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 Blaylock-Taussig, or BT, shunt) or directly from the right ventricle (with a Sano shunt) to the pulmonary artery.

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 3 to 4 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 Norton Children’s Heart Institute?

Norton Children’s Heart Institute, affiliated with the University of Louisville, is a comprehensive pediatric heart surgery, heart failure and heart transplant program serving Kentucky, Southern Indiana and beyond.

The goal of the full-service Norton Children’s Heart Institute is to provide care for the child and the whole family. Our specialists are prepared to repair even the most complex congenital and acquired heart conditions.

Our heart team includes:

• Pediatric cardiothoracic surgeons
• Pediatric transplant surgeons
• Pediatric cardiologists
  • Fetal cardiologists
  • Adult congenital heart cardiologists
  • Heart failure/heart transplant cardiologists
  • Pediatric electrophysiologists
  • Pediatric cardiac catheterization cardiologists
• Pediatric cardiovascular anesthesiologists
• Pediatric intensive care physicians
• Cardiac critical care nurses
• Critical care pharmacists
• Family support team
• Child life specialists
• Rehabilitation specialists
• Social workers