The Norwood is the first of the three heart operations. It is most often done during the first week of life.
Since the heart's left side does not pump well, the heart is rebuilt so the right side of the heart becomes the main pumping chamber. After the Norwood, the right ventricle pumps blood to both the lungs and the body.
The blood vessel leaving the right side of the heart called the pulmonary artery is divided. The far end (the end closest to the lungs) is sewn shut. The near end (the end closest to the heart is sewn into the aorta, which is the large blood vessel leaving the left side of the heart. A patch is sewn in this area to make the "new aorta" or neo-aorta bigger and stronger. Now all the blood leaving the heart goes from the right side of the heart through the pulmonary valve and out to the body through the new aorta (1).
A hollow tube that connects the new aorta to the pulmonary artery is sewn in place (2). The tube is called a Blalock-Taussig (BT) shunt. The BT shunt lets some of the blood pumped to the body go to the lungs.
The wall between the heart's two upper chambers is removed (3). This allows red blood coming back from the lungs to flow from the left upper chamber to the right upper chamber. The blood then goes to the right lower chamber and out to the body.
After the Norwood operation, the right heart pumps a mixture of red and blue blood out to the body. It pumps blue blood coming back from the body and red blood coming back from the lungs. Since mixed blood is going out to the body, the oxygen level in the blood is lower than normal. This makes the baby's lips look a little "dusky" or blue and is more noticeable when the baby cries. Since the baby's body is used to a lower oxygen level, it does not hurt him to cry even he looks bluer.
Most babies go home ten days to two weeks after the Norwood operation is done. They often go home on three or four heart medicines. Some babies need to use a feeding tube for part of their feedings, at least for the first several weeks. Babies with heart problems often need extra calories in their milk. Breast milk is very good for children with heart problems as it is for all babies. Mothers of babies with heart defects can breast feed and breast milk can be given in the tube feedings. Supplements can be added to the breast milk if the baby needs more calories.
Parents learn about their baby's care before discharge from the hospital. They will be able to feed their baby and give the medicines that will be needed at home. In this way, parents come to know that they can care for their baby's special needs. Many parents choose to have a nurse visit their home after the baby leaves the hospital. The nurse can answer questions, assess how the baby is doing, and help parents learn more about their baby's care.
After the Norwood, most babies grow well and learn to smile, roll over, and play with their toys like other babies. Some babies have trouble gaining weight and need richer milk to drink. Some are slow to learn motor skills. Babies who are slow to develop often benefit from special help that can be arranged through the local school district, among other places.