The Norwood Procedure

The Norwood procedure is surgery that changes the way a baby’s heart connects to the lungs and body. It is necessary when babies are born with heart defects that prevent half of their heart from working properly.

Newborns at Children’s Health have had a 100% survival rate after the Norwood procedure in recent years.

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What is the Pediatric Norwood Procedure?

Normally, the right side of your heart pumps blood through the lungs to collect oxygen. Then the blood passes into the left side of your heart, which pumps it to the rest of your body where the oxygen is used.

When babies are born with problems like hypoplastic left heart syndrome, the part of the heart that delivers blood to the body is underdeveloped and isn’t able to do its job. They need another way to circulate blood so that their body gets the oxygen it needs.

We do a series of three surgeries to make that happen. The first one is the Norwood procedure, which we usually do shortly after the baby is born.

The Norwood procedure involves three main changes:

We create a large and dependable connection between the heart and the artery to the body.
We create a new, appropriate-sized connection to deliver blood to the lungs. This connection is a small plastic tube and may be a Blalock-Taussig shunt or a Sano shunt, depending on your child’s condition.
We enlarge the opening between the upper chambers of the heart to be sure that oxygen rich blood has an unobstructed pathway back from the lungs to the heart.

A few months after the Norwood procedure, we’ll do a surgery called the Glenn procedure. This surgery replaces the shunt and provides a source of blood flow for the lungs that will grow with the patient. A few years after that, a third and final operation called the Fontan procedure is performed to maximize the amount of blood flow to the lungs.

What are the benefits of the Pediatric Norwood Procedure?

This is a lifesaving surgery for babies who need it. The procedure enables their hearts to pump blood to their lungs and bodies in appropriate amounts, even though half of their heart isn’t able to function.

What are the risks of the Pediatric Norwood Procedure?

In rare cases, the heart may be unable to sustain the circulation at appropriate levels, and it may be necessary to use a blood pump, called ECMO or left ventricular assist device (LVAD), to support the function of the heart. If the heart can recover, the pump can be removed, but if not heart transplantation may be the only solution. As with any open heart surgery, there are also potential complications such as bleeding, infection, stroke or temporarily poor kidney function which may occur. Our team monitors babies continuously to watch for any problems.

What are Children’s Health’s outcome metrics for the Pediatric Norwood Procedure?

In 2020 and 2021, our surgical team has had 100% survival among newborns who have the Norwood procedure. This is better than the national survival rate, which is 85%.

What to expect with the Pediatric Norwood Procedure

We find out a baby needs this surgery when the mother has an ultrasound during her prenatal care. This helps us prepare for the baby’s care ahead of time. We usually do the Norwood procedure within a week of the baby’s birth.

What to expect before the Norwood procedure

Babies who need this surgery are admitted to intensive care soon after birth. There we can monitor the baby and provide medicine that helps their blood flow until it’s time for surgery.

What to expect during the Norwood procedure

The entire procedure takes about six to eight hours. We carefully monitor your baby’s heart function throughout the operation. Before we’re done, we get an image of the heart to make sure there aren’t any lingering issues requiring more surgery.

What to expect after the Norwood procedure

Babies usually stay in intensive care for two to three weeks following surgery, where they are continuously monitored by a multidisciplinary team. After they recover enough to leave the intensive care unit, they are transferred to the cardiac acute care unit where they and their parents are prepared for eventual departure from the hospital. This process typically takes an additional two to three weeks. We also provide specialists to help with feeding and other issues.

When you go home, your child may need to take heart medicine or baby aspirin. Our patients are enrolled in a unique program called Safe at Home to help you manage your child’s care after leaving the hospital, with our medical team on call whenever you need us.

What questions should I ask my provider about the Pediatric Norwood Procedure?

What other surgeries may be necessary for my child?
What sort of lifestyle or activities will be possible for my child as they grow up?
What sort of risks will they face?
What support do you have for kids and families with our needs?

Frequently Asked Questions

Will my child need a heart transplant after this surgery?

Transplant is a possibility for many kids who are treated initially with a Norwood procedure. This and the other surgeries we do help them grow up with their own heart for as long as possible. Children’s Health℠ has an expert heart transplant team and the Adult Congenital Heart Disease Program to care for kids and adults who have had the Norwood and related procedures.
What’s the next step in my child’s care?

A few years after the Norwood procedure, most kids will go on to have a surgery called the Glenn procedure. This surgery changes the way blood flows from the upper body to the heart and lungs. A few years after that, a third and final operation called the Fontan procedure is performed to maximize the amount of blood flow to the lungs. In preparation for the Glenn and Fontan procedures, additional diagnostic tests including echocardiograms, cardiac catheterization, cardiac CT scan, and cardiac MRI may be performed to assess readiness for the planned operations.