Norwood Procedure in Thailand

Norwood procedure is a type of a heart surgery conducted to treat patients with hypoplastic left heart syndrome, mitral atresia, and other types of congenital heart defects that result in a single ventricle for blood circulation. This surgery, performed for the first time in 1981, is conducted in three steps.

Norwood procedure is conducted in patients whose heart is not able to pump blood to the different parts of the body. As a part of Norwood surgery, the doctors connect the single ventricle in the heart to the systemic circulation. To be able to do this, the surgeons first stop the circulation of the impure blood to the lungs from the ventricles and create an alternative pathway for it. During the Norwood surgery, the right side of the heart is resurrected as the main pumping chamber. Sometimes, it is the right ventricle that supplies blood to both the lungs and the rest of the body parts.

Norwood surgery is mostly conducted during the first week of life. It is usually conducted as a part of a series of heart surgeries required to correct the heart defect. It involves the reconstruction of the aorta using the pulmonary artery. During the same surgery, a Blalock-Taussig (BT) shunt is placed to maintain the flow of blood from the heart to the lungs.

The following three steps are performed during the surgery:

Step 1: Creation of a new aorta

The surgeons first split the pulmonary artery into two parts. The end closest to the lungs is sewn and the far end is sewn into the aorta. A patch is put on this conjunction is make the new aorta stronger and bigger. This way, the blood leaving the heart through the pulmonary valve in the right side to the rest of the body travels through the newly created aorta.

Step 2: Placement of a BT shunt

A BT shunt is a hollow tube that connects the pulmonary artery to the new aorta. It helps pump some blood that eventually reaches the lungs.

Step 3: Removal of walls between the atria

In the last step, the wall between the upper two chambers of the heart, the atria, is removed. This allows the flow of blood coming back from the lungs to the right upper chamber. The blood eventually reached the right lower chamber (ventricle) and is pumped to the rest of the body.

After the surgery, once the blood circulation resumes, the right side of the heart of the baby pumps a mixture of blue and red blood. Blue blood is the deoxygenated blood that comes from the different parts and red blood is the oxygenated blood coming from the lungs. This gives a blue or a dusky appearance to the skin and the lips of the baby.

Because the blood of the baby is mixed, the oxygen level in the blood circulating in the body is less than normal. However, the body of the baby adjusts to this levels and is not affected by it. A majority of babies who undergo Norwood surgery are released from the hospital after 10 days of the surgery. Doctor prescribe three to four medications that must be given to the baby in the days to come.  Breastfeeding is highly recommended for babies who have had a heart surgery. Some babies may be given breast milk through a feeding tube for a few days before normal feeding is resumed. For increased calories intake, breast milk can be supplemented with extra powders and other add-ons.

Parents of the baby must learn how to care for the baby at home and feed them. They must learn all the necessary skills from the nurse and take guidance from the surgeon. Babies who have had a Norwood operation grow normally like any other baby. They smile and roll over and the rest of the developmental stages are the same. Some babies may, however, face trouble gaining weight and they must be given richer milk to drink for normal development.