Norwood Procedure

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Norton Children’s Heart Institute

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

HLHS once was considered inoperable. Advances such as the three procedures currently used to treat single-ventricle conditions give more babies the chance to live full lives.

The Norwood procedure 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 surgeries.

After the Norwood procedure, the child will go home to grow and gain strength for the second surgery, usually at age 4 to 6 months. During this time, the family will have a specially equipped iPad and other equipment to monitor vital signs and other data, which is immediately sent to the team at Norton Children’s Heart Institute at least once a day. This allows providers to react quickly when a child’s condition changes — sometimes even before the parents realize something is wrong.

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 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, the Norwood procedure includes building a new path from the heart to the lungs. 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.

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, the Glenn procedure, during which the surgeons will create a more permanent solution.

  • Closing the ductus arteriosus. The ductus arteriosus starts off open, but 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. Once the right ventricle takes 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  You’ll be given a scale for accurate weight tracking
  • Oxygen levels with a pulse oximeter that you will be given

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
An illustration shows hypoplastic left heart syndrome
An illustration shows the Norwood Procedure
An illustration of bloodflow after the Norwood Procedure

Between the Norwood procedure and the next surgery, the Glenn procedure, you’ll use the specially equipped iPad to transmit data to the Norton Children’s Heart Institute team.

Why Choose Norton Children’s Heart Institute

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

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