Norwood Procedure

SYMPTOMS

As the cause of this condition is prevalent in newborn babies, the symptoms are easily observable and identifiable. The several symptoms that may urge a neonatal cardiologist to consider the application of a Norwood procedure can be surmised as;

• Having a grey-blue skin colour, also known as cyanosis.    
• Rapid breathing or facing difficulty in inhalation.
• Reduced feeding
• Low temperature in the extremities, especially the limbs.
• Slow and labored heartbeat.
• Showing drowsiness or long periods of inactivity.
• Dull and unblinking eyes.

DIAGNOSIS

In many cases, conditions that need a Norwood procedure can be identified even when the fetus has not left the womb. After delivery, the baby may appear grayish-blue in color, be inactive, and have difficulty breathing. 

Diagnostic analysis for hypoplastic left heart syndrome depends on the child's stage of development, medical conditions etc. Some tests that may be suggested the doctor can include the following:

• Chest X-ray: A diagnostic test that uses high-wavelength and invisible X-ray radiation to get a 2D image of internal tissues, bones, and to identify any structural issues in the organs.
• Electrocardiogram: This test is used to detect uncharacteristic rhythms (arrhythmias or dysrhythmias) of the heart, and test for damages in the heart muscles.
• Echocardiogram: This procedure is used by applying sound waves that can detect structural and functional anomaly of the heart. Almost every case of hypoplastic left heart syndrome is detected by this procedure.

Also, Magnetic Resonance Imaging, Ultrasound and other test can also be done to get the diagnosis of this condition.

RISK FACTORS

Application of the Norwood surgical procedure for hypoplastic left heart syndrome may include risks and complications as:

• Having poor stamina and getting exhausting easily when participating in any workout, exercise or physical activity.
• Recurrent abnormalities in heart rhythms (arrhythmias or dysrhythmias).
• Retention and buildup of fluid in the lungs, stomach, legs and feet; giving rise to pulmonary, abdominal, and tissue edema respectively.
• Restrictive growth will ill-developed physical features.
• Development of blood clots that may cause a pulmonary embolism or stroke.
• Progressive complications related to the brain and nervous system
• Need for further heart surgery or transplantation.

POST-OPERATIVE CARE

• The patient may be admitted to the neonatal intensive care unit (NICU) for a short duration after the surgery.
• An IV channel will be created to give nourishment, medications, and other factors to the patient. 
• A catheter may be applied to support micturition.
• Your child may need follow-up care for his or her whole life.
• The doctor may suggest a must-have course of antibiotics before any dental or other procedure.
• Have a consultation with your doctor, if you are a woman and planning to be pregnant and starting a family.

TREATMENT

Management of illnesses that has the need of a Norwood procedure with medicines will not be operational in the long run, as they will only work to keep the apertures open for a little longer, which may abate the symptoms for the time being. According to the age of the patient and the development of the disease indicators, the pediatric surgeon may mention the following tips for before, during and after the surgery;

Before surgery

The surgeon may recommend several tips for the smooth operation of your baby. Some of them can be stated as;

• Hospital staffs may take your family history, any medicine usage by the parents, and any case of hypersensitivity to certain drugs.
• Medicines that keep the ductus arteriosus open and help in dilating the blood vessels may be given.
• If your child has trouble breathing, he or she may be attached to a breathing machine or ventilator, which will help in having a continuous source of oxygen.
• Your baby will be given medicines and solutions through an intravenous channel.
• A feeding tube may be applied if your child gets tired while feeding or has difficulty in it.
• A procedure to create or enlarge the aperture between the cardiac upper compartments may be performed to ensure the increase of blood flow between the right and left atrium if the foramen ovale is closed or too narrow. This is known as atrial septostomy. If your child has atrial septal defect, then this operation will not be necessary.

During the procedure;

• Your child will be positioned in the surgical table in a supine position.
• Your baby will be most likely made totally unconscious.
• He or she will be linked to a heart-lung bypass machine which will keep the flow of blood ongoing during the operation of the cardiac chambers.
• The surgeons will rebuild the aorta and make a direct connection to the right ventricle, the heart's lower right chamber.
• The pediatric cardiac surgeon will attach a tube or shunt that unites the aorta to the blood vessel leading to the lungs, also known as pulmonary arteries, or place a bypass that connects pulmonary arteries to the right ventricle. 
• Alternatively, the surgeon(s) may transplant a stent in the ductus arteriosus to sustain the aperture present between the pulmonary artery and aorta, put bands surrounding the pulmonary arteries to diminish blood flow to the lungs, and produce an alternative pathway between the atria of the heart.

The surgery may take up to six to eight hours, depending upon the state and medical history of the patient.

FACTORS AFFECTING COST

The cost of Norwood procedure for the treatment of hypoplastic left heart syndrome will be greater than an open-heart surgery and may change according to the following;

• The operation theater charges.
• The charges of the pediatric cardiologist and any other specialist.
• The life-sustaining instruments (ventilator, heart-lung machine).
• The cost of the drugs administered.