World Library  
Flag as Inappropriate
Email this Article

Norwood procedure

Article Id: WHEBN0003321060
Reproduction Date:

Title: Norwood procedure  
Author: World Heritage Encyclopedia
Language: English
Subject: Sano shunt, Cardiac surgery, Interventional cardiology, Blalock–Hanlon procedure, Batista procedure
Collection: Cardiac Surgery, Congenital Heart Disease
Publisher: World Heritage Encyclopedia

Norwood procedure

Norwood procedure
Diagram of a healthy heart and one suffering from Hypoplastic left heart syndrome. In the heart on the right, note the near absence of the left ventricle, which normally provides systemic circulation. In the Norwood procedure, blood flow from the right ventricle is rerouted to serve this function, which means that an alternative source of pulmonary circulation must be provided.
ICD-9-CM 35.8

The Norwood procedure is a surgery performed on the heart. A stage 1 Norwood procedure for hypoplastic left heart syndrome involves atrial septectomy and transection and ligation of the distal main pulmonary artery. The proximal pulmonary artery is then connected to the hypoplastic aortic arch, while the coarcted segment of the aorta is repaired. An aortopulmonary shunt is created to connect the aorta to the main pulmonary artery to provide pulmonary blood flow. The first successful use of the procedure was reported by Dr. William Imon Norwood, Jr. (1941 – ) and colleagues in 1981.[1][2]

Cardiopulmonary bypass is required.[3]


  • Indications 1
  • Process 2
    • Providing systemic circulation 2.1
    • Providing pulmonary circulation 2.2
  • References 3
  • External links 4


This procedure is most often performed to treat hypoplastic left heart syndrome, certain types of mitral atresia, or other conditions that result in single ventricle circulation.

In these conditions, the most urgent problem is that the heart is unable to pump blood to the systemic circulation (i.e. to the body). The goal of the Norwood procedure is to connect the single ventricle to the systemic circulation. To accomplish this, blood flow to the lungs is disrupted, and therefore an alternative path must be created to supply the lungs.


Entry to the body cavity for the Norwood procedure is gained by a vertical incision above the sternum. Separation of the sternum is necessary.

This surgery is complex and may vary slightly depending on the diagnosis and overall condition of the heart.

The surgery on the heart can be divided into two main steps.[4]

Providing systemic circulation

The main pulmonary artery is separated from the left and right portions of the pulmonary artery and joined with the upper portion of the aorta. Widening of the pulmonary artery is often necessary, and may be accomplished by using the patient's existing biological tissue, or appropriate animal tissue. This allows the blood, a mixture of oxygenated and deoxygenated, to be pumped to the body via the morphologic right ventricle, through the pulmonary valve.

Providing pulmonary circulation

Since the remainder of the pulmonary artery is now disconnected from the heart, one of a few techniques must be used to supply blood to the lungs:

  • With a modified Blalock-Taussig Shunt, a Gore-Tex conduit (a kind of plastic tubing) is used to connect the subclavian artery to the pulmonary artery. In this case, blood comes from the single ventricle, through the pulmonary valve, the reconstructed aorta, the subclavian artery, and the conduit, to the lungs. There are variations on this procedure where the origin of the shunt is elsewhere in the systemic circulation (e.g. from the aorta itself) rather than the subclavian artery.
  • With a Sano shunt, a hole is made in the wall of the single ventricle, and a Gore-Tex conduit is used to connect the ventricle to the pulmonary artery. The key difference here is that the blood flow is more pulsatile than with the Blalock-Taussig version.

After this first step (switching the right ventricle in functional position of the absent left ventricle) children generally proceed down the path to a Fontan procedure.


  1. ^ Norwood, WI; Lang, P; Casteneda, AR; Campbell, DN (October 1981). "Experience with operations for hypoplastic left heart syndrome.". The Journal of thoracic and cardiovascular surgery 82 (4): 511–9.  
  2. ^ Norwood, William I.; Lang, Peter; Hansen, Dolly D. (6 January 1983). "Physiologic Repair of Aortic Atresia–Hypoplastic Left Heart Syndrome". New England Journal of Medicine 308 (1): 23–26.  
  3. ^ Ricardo Munoz; Victor Morell; Peter Wearden (August 2009). Critical Care of Children with Heart Disease: Basic Medical and Surgical Concepts. Springer. pp. 326–.  
  4. ^ A. Corno; Gigi P. Festa (8 December 2008). Congenital Heart Defects. Decision Making for Surgery: CT-Scan and Clinical Correlations. Springer. pp. 123–.  

External links

  • [3], Health Centers Online
  • University of Michigan - HLHS - Stage 1 Norwood Procedure [4]
This article was sourced from Creative Commons Attribution-ShareAlike License; additional terms may apply. World Heritage Encyclopedia content is assembled from numerous content providers, Open Access Publishing, and in compliance with The Fair Access to Science and Technology Research Act (FASTR), Wikimedia Foundation, Inc., Public Library of Science, The Encyclopedia of Life, Open Book Publishers (OBP), PubMed, U.S. National Library of Medicine, National Center for Biotechnology Information, U.S. National Library of Medicine, National Institutes of Health (NIH), U.S. Department of Health & Human Services, and, which sources content from all federal, state, local, tribal, and territorial government publication portals (.gov, .mil, .edu). Funding for and content contributors is made possible from the U.S. Congress, E-Government Act of 2002.
Crowd sourced content that is contributed to World Heritage Encyclopedia is peer reviewed and edited by our editorial staff to ensure quality scholarly research articles.
By using this site, you agree to the Terms of Use and Privacy Policy. World Heritage Encyclopedia™ is a registered trademark of the World Public Library Association, a non-profit organization.

Copyright © World Library Foundation. All rights reserved. eBooks from Project Gutenberg are sponsored by the World Library Foundation,
a 501c(4) Member's Support Non-Profit Organization, and is NOT affiliated with any governmental agency or department.