Norwood Procedure

The Norwood Procedure is one of the most critical and life-saving surgeries performed for newborns with Hypoplastic Left Heart Syndrome (HLHS), a severe congenital heart defect where the left side of the heart is underdeveloped. For parents, receiving this diagnosis can be overwhelming, but with today’s advanced pediatric cardiac care, survival and long-term outcomes have improved significantly.

India has become a leading global destination for this surgery due to its highly skilled pediatric cardiac surgeons, advanced children’s hospitals, and significantly lower costs compared to Western countries. Families from Africa, the Middle East, Europe, and South Asia regularly travel to India for expert care, modern facilities, and strong post-operative support systems. The cost of the Norwood procedure in India ranges from USD 10,000 to USD 22,000.

What is a Norwood Procedure?

The Norwood Procedure is the first of three staged surgeries used to treat babies born with Hypoplastic Left Heart Syndrome. Because the left ventricle is too small to pump blood effectively, the Norwood procedure creates a pathway that allows the right ventricle to take over the job of pumping blood to the entire body.

It is usually performed within the first week of life and is essential for survival. The two follow-up surgeries (Glenn and Fontan) are performed later as the child grows.

Key Goals of the Norwood Procedure:

• Reconstruct the aorta.
• Redirect blood flow to support the body.
• Insert a shunt to supply blood to the lungs.
• Allow the right ventricle to act as the main pumping chamber.

Types of Norwood Procedure Techniques

Different variations of the Norwood Procedure are used depending on the baby’s condition and the surgeon’s expertise.

1. Classic Norwood (Modified Blalock-Taussig Shunt): A tube is placed between the subclavian artery and pulmonary artery to provide blood flow to the lungs.
2. Sano Modification: A conduit is placed between the right ventricle and pulmonary artery. It provides more stable blood flow and a lower risk of complications.
3. Hybrid Approach: A less invasive method combining catheter-based procedures and surgery. Often used for newborns who are medically fragile or premature.

Each technique is chosen based on oxygen levels, heart anatomy, and the child’s overall health.

Who is a Good Candidate for a Norwood Procedure?

This surgery is performed on newborns diagnosed with:

• Hypoplastic Left Heart Syndrome (HLHS)
• Severe left-sided structural heart defects
• Aortic and mitral valve abnormalities
• Underdeveloped left ventricle

Ideal candidates:

• Newborns diagnosed early
• Babies with stable birth weight
• Infants without major chromosomal abnormalities
• Babies medically fit for bypass surgery

A team of neonatologists, pediatric cardiologists, and cardiac surgeons evaluates the case before planning surgery.

Pre-Surgery Preparation & Diagnostics

Before the Norwood Procedure, doctors perform thorough assessments to stabilize the baby and plan the surgery.

Important Diagnostics Include:

• Echocardiography
• Chest X-ray
• Blood gas tests
• MRI or CT scan (if needed)
• Electrocardiogram
• Preoperative blood work
• Oxygen saturation monitoring

Stabilization Steps:

• Prostaglandin infusion to keep the ductus arteriosus open
• Ventilation support
• Managing fluid levels
• Continuous heart monitoring

Parents receive counseling to understand the stages of surgery and long-term expectations.

What’s Included in the Package?

Typically Included:

• Pediatric cardiac surgeon consultation
• Norwood Procedure surgery
• ICU stay (5-7 days)
• Hospital stay (10-14 days)
• Anesthesia & operating charges
• Pre-operative tests
• Post-operative medications
• Physiotherapy and feeding support
• Follow-up reviews during stay

Not Usually Included:

• Additional cardiac complications
• Extended ICU stay
• Long-term medications
• Future staged surgeries (Glenn, Fontan)
• Accommodation outside the hospital
• International travel