Should your baby have the Norwood Procedure? Let's talk about it simply.

How scared and shocked you must have felt when the doctors told you that your little one had a complex congenital heart condition? When they told you that you needed to have a 'Norwood Procedure', you probably didn't even understand the word. It's very common. At a time like this, a thousand questions come to mind. Don't worry, we'll talk about this very simply, in a way that you can understand.

What is the Norwood Procedure?

Simply put, the Norwood procedure is the first and most major surgery performed to save the lives of babies born with a very complex congenital heart defect. We call this heart condition Hypoplastic Left Heart Syndrome (HLHS) .

Now look, a healthy heart has four main chambers. The right side is responsible for sending the body's oxygen-poor blood to the lungs. The oxygen-rich blood from the lungs comes to the left side of the heart. The left side is responsible for pumping this oxygen-rich, clean blood to the entire body.

However, the left side of a baby's heart with HLHS is not fully developed. This means that the main part that pumps clean blood to the body does not work. So it is difficult for such a baby to survive.

This is when the doctors perform the Norwood procedure. This procedure allows the right side of the baby's heart, which is already working well, to do the work that the left side should do. That is, the heart's blood flow is changed so that the right ventricle pumps blood to the lungs, while at the same time pumping oxygenated blood to the entire body.

Who needs this surgery?

This surgery is mainly needed for babies with the HLHS condition we talked about earlier. These babies need this surgery within the first two weeks of birth.

Imagine, when the baby is in the womb, this weakness of the heart is not a problem because it receives oxygen from the umbilical cord. Even after birth, for the first few days, a small tube-like part of the heart between the main blood vessels (aorta and pulmonary artery) (patent ductus arteriosus) remains open. This allows some blood to flow to the body.

However, this tube naturally closes in a few days. That's when the baby has difficulty breathing, and his life is at great risk. Therefore, the doctors give him a special medicine to keep the tube from closing. In the meantime, the baby is prepared for this Norwood operation.

Sometimes, for babies who are born prematurely, have low birth weight, or have other serious health problems, this surgery may not be possible at once. In such cases, doctors may resort to other temporary methods.

What happens during the surgery?

This is a very complex surgery that takes several hours, sometimes even a day. Here's what the doctor does in simple terms:

1. Enlarging a hole between the upper chambers (atria) of the heart: This helps oxygenated blood from the lungs to flow more easily into the right side of the heart.

2. Reconstruction of the main artery (aorta): The baby's small, underdeveloped aorta is connected to the pulmonary artery, the artery that carries blood to the lungs, and a special patch is inserted to create a single, large, strong blood vessel.

3. Connecting the new artery to the right ventricle: Now this newly created large aorta is connected to the right ventricle, the only working part of the heart. Now the right side can pump blood to the entire body.

4. Placing a shunt to send blood to the lungs: Since all the blood is now going through the new aorta to the body, a separate route needs to be created to send blood to the lungs. This is done using a small tube called a shunt. This is connected from the new aorta to the pulmonary arteries (Blalock-Taussig or BT shunt) or from the right ventricle to the pulmonary arteries (Sano shunt).

During this entire surgery, the baby's heart and lungs are temporarily operated by a special machine called cardiopulmonary bypass .

What happens after the surgery?

After surgery, your baby will be admitted to the Intensive Care Unit (ICU) , where specially trained doctors and nurses will care for your baby 24 hours a day.

You will see that there are many tubes and wires connected to the baby's body. They are used to give the baby the necessary medicine, oxygen, food, and constantly measure the body's functions. Don't be afraid to see them , they are all there for the baby's well-being.

Even after surgery, as we discussed earlier, the baby's skin and lips may have a slight blue tinge due to the mixing of high-oxygen and low-oxygen blood. This is normal at this point.

After about a week in the intensive care unit, once the baby's condition improves, you will be transferred to a regular ward. Before you go home, the doctors and nurses will give you a thorough explanation of how to care for your baby, how to give him medication, and what symptoms to watch out for.

Complete surgical series for HLHS condition

The Norwood procedure is just the first step in this journey. For a baby with HLHS to have a normal life, they need to undergo a series of three surgeries.

What are the possible risks and complications?

As with any major surgery, the Norwood procedure carries some risks. Your doctor will explain these to you. The main complications that can occur are:

• Narrowing of blood vessels: After surgery, the reconstructed aorta or the artery that carries blood to the lungs may become narrowed (stenosis).
• Shunt problems: The shunt that sends blood to the lungs may become blocked or not work properly.
• Abnormal heartbeat: The heart's rhythm can change (arrhythmia).
• Weakened heart function: The heart's pumping ability or the function of its valves may be impaired.
• Neurodevelopmental delays: There is a small chance that brain development will be affected, leading to learning or behavioral problems (Neurodevelopmental delay).

How are the results and survivability?

This is the biggest question every parent has. The truth is, before this surgery was discovered in the 1980s, there was no treatment for babies born with HLHS. The Norwood procedure is a chance for these babies to live.

According to statistics, the chance of survival in the hospital after this operation is about 90% . The five-year survival rate after the operation is between 60% and 75%. Some babies, unfortunately, may die suddenly before reaching the stage of the second operation.

However, if all three surgeries are successful, these children can grow into young adults. They will have the opportunity to go to school, play, and live a normal life.

When should I see a doctor?

After bringing your baby home, you have a big responsibility. You need to be very careful about the following things. If you notice anything like this, call your doctor immediately.

• If the baby is not gaining weight properly.
• If your baby's oxygen level drops below the level your doctor told you (you will have been given a device to measure oxygen at home).
• If the baby is not responding well to the prescribed medication.
• If you have any questions or doubts about how to care for your baby.

Because HLHS is a rare condition, it is very important to choose an experienced doctor and hospital that performs this type of surgery frequently. Don't be afraid or embarrassed to ask your doctor repeatedly about anything you don't understand.

Norwood Procedure, HLHS, Hypoplastic Left Heart Syndrome, Pediatric Heart Surgery, Congenital Heart Disease, Pediatric Heart Disease