Norwood Procedure and Biventricular Repair

from Practice Update, Winter 2004

The Norwood ’s staged reconstruction is accomplished in three surgeries. The first procedure, taking place within a few days of birth, reconstructs the aorta and pulmonary arteries so that both systemic and pulmonary blood flows are directed through the right ventricle. Next, the bidirectional Glenn procedure, typically done at four to six months, redirects circulation so that blood from the superior vena cava can flow either right or left once it enters the right pulmonary artery, beginning the separation of systemic and pulmonary circulations. Finally, the Fontan procedure, usually done between one and three years of age, completes the separation of systemic and pulmonary circulations, essentially creating a single ventricle. Following the Fontan, oxygen levels, though less than normal, are still at 90 to 95 percent of expected levels. Though most children with HLHS will need very close follow-up and medications throughout their lives, they can expect to participate in most childhood activities, with the exception of contact sports.

Biventricular repair (BVR) reconstructs the heart so that two ventricles result. BVR is sometimes preceded by a palliative Norwood . (BVR is not appropriate for patients with certain morphologies, such as mitral valve anomalies.) Advancements in biventricular repair include the ability to perform increasingly complex reconstructive surgery and soon after birth less invasive techniques that improve outcomes and leave less scarring. New procedures that encourage growth in the hypoplastic ventricle also make BVR possible using the body’s own resources to help accomplish repairs.