Treatment for Your Child’s Single Ventricle Heart defect: Stage I Surgery
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| In a normal heart, oxygen-poor blood is pumped to the lungs from the right ventricle. Oxygen-rich blood is pumped to the body from the left ventricle. |
Your child has a heart problem that is a single ventricle heart defect. The most common treatment is heart surgery. This is often done in 3 stages. Treatment is complicated. It requires careful management of your child’s health. And treatment does not fix your child’s heart problem. But it can ease symptoms and increase your child’s chances to live a more normal life. You and your child’s healthcare provider have decided that the benefits of this surgery outweigh any risks. This sheet helps you understand the surgery that is done during the first stage. Your child’s cardiologist or surgeon can answer your questions and tell you more as needed.
The goals of heart surgery for single ventricle heart defects
- Stage I. Make the one working ventricle the main pumping chamber of the heart. This provides stable blood flow to both the lungs and the body.
- Stage II. Ease the workload of the one ventricle. This reduces the mixing of oxygen-poor and oxygen-rich blood.
- Stage III. Separate the circulation of blood in the heart. This means very little oxygen-rich and oxygen-poor blood mix.
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Risks and possible complications of heart surgery
Risks and possible complications include:
- Infection
- Bleeding
- Problems with the nervous system, such as seizure or stroke
- Abnormal heart rhythm (arrhythmia)
- Abnormal buildup of fluid around the heart or lungs
- Problems in the lungs
- Damage to the nerves that control the vocal cords or the diaphragm
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Stage I: The Norwood procedure
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| The Norwood procedure makes the right ventricle the main pumping chamber of the heart. The ventricle can then provide blood flow to the entire body. The surgery also makes sure blood to and from the lungs goes to the right ventricle. |
The first stage of surgery is called the Norwood procedure. It is generally done within the first week after birth. Your child may need to stay in the hospital for 3 to 5 weeks after surgery. Your child will need this surgery if the aorta or other left heart structures are too small or missing. This includes hypoplastic left heart syndrome (HLHS). The surgery rebuilds the heart so that the right ventricle is used as the main pumping chamber. Blood can then be pumped from the right ventricle to the rest of the body to deliver oxygen. During the surgery, the surgeon does the following:
- Atrial septectomy. The surgeon removes the wall dividing the two upper heart chambers (atrial septum). This allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium.
- Reconstruction of aorta. The surgeon divides the main pulmonary artery. This artery, along with patch material, is used to rebuild the aorta. This is called the neoaorta or “new” aorta. Blood from the right ventricle can then be pumped through the pulmonary valve to the new aorta. This sends blood from the right ventricle directly to the body instead of to the lungs.
- Placement of shunt (tube). The surgeon creates a new pathway to send blood to the lungs. This is because the main pulmonary artery has been used to rebuild the aorta. So the surgeon places a shunt. It connects an artery branching from the aorta to the pulmonary artery. This allows a controlled amount of blood to reach the lungs. As an alternative, the surgeon may use a technique called the Sano method instead of the shunt. In this case, the surgeon places a tube from the right ventricle to send blood directly to the pulmonary arteries that are connected to the lungs.
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When to call the healthcare provider
After any of these surgeries, call your child's healthcare provider right away if your child has any of the following:
- Increased redness, draining, swelling, or bleeding at the incision site
- Fever of 100.4°F (38°C) or higher, or as directed by your child's healthcare provider
- Trouble feeding/eating, poor appetite, or weight loss
- “Red Flags” as described in home monitoring notebook
- Shortness of breath or difficulty breathing
- Flaring of the nostrils
- Color changes (gray, pale or blue) of the skin, lips or fingernails
- Cough that won’t go away
- Increased tiredness or irritability
- Prolonged nausea or vomiting
- Irregular heartbeat
- No noticeable improvement or you don't think your child is getting better
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The Norwood procedure makes the right ventricle the main pumping chamber of the heart. The ventricle can then provide blood flow to the entire body. The surgery also makes sure blood to and from the lungs goes to the right ventricle.