The Norwood Procedure

Here is a description of the procedure that Lynnea will have later this morning (yes, I'm posting this in the middle of the night because I needed to do something while the people from vascular access are putting IV's in Lynnea). The top picture is a picture of what Lynnea had done during her first heart surgery. She had the stent placed in her PDA (green), and bands placed on her pulmonary artery (purple). During the Norwood procedure, her stent will be removed, and the bands will be removed (yes, they are going to completely undo everything that they did in the first surgery). The second picture is a picture of what they will do today. They will be reconstructing her aortic

arch. The red lines on the drawing indicate what this will look like when they are done. Her aorta (blue) is small, and at one point becomes very narrow (the yellow area), so they take her pulmonary artery and combine it with her aorta, so that the aorta is big enough to handle all of the blood flow out from her heart to the rest of her body. Her PDA (green) will no longer exist. A B-T shunt (brown) will be placed between her aorta and what's left of her pulmonary artery in order to provide blood flow to her lungs. In addition to this, the hole that she has between her Right Atrium (RA) and Left Atrium (LA) will be made permanent (this hole is her PFO - orange on the drawing).

Dr. St. Louis (her surgeon) says that he thinks things should go well, but he is a little concerned about the fact that her valve between her Right Atrium and her Right Ventricle has been leaking; he says that sometimes this is an indicator that things may not go as well as he would like. He is also concerned because her Right Ventricle has been working very hard and has become a little bit thick and stiff, which can also lead to problems.

During the surgery, Lynnea will be placed on a heart-lung bypass machine. There will be approximately 4 minutes when she will have to undergo complete circulatory arrest; during this time there will be no blood flow to her brain.

After the surgery, her chest will remain open for at least 2-3 days, or until the swelling goes down enough to close it up. During this time, we won't be able to hold her. If all goes well, she will spent about a week in the PICU, and then a few days in 5A before she will be able to go home. Dr. St. Louis explained that there is about a 10% mortality rate with this procedure (if we had done this procedure on Lynnea as a newborn, the mortality rate would have been 15%), and he says that there is a 3% chance that she could have a stroke.

Keep Lynnea in your prayers today as she goes through this major surgery. Her surgery is scheduled to start around 8:30am. From the time they take Lynnea to begin anesthesia, to the time when we can see her again in the PICU, will probably be between 6-8 hours. The actual procedure itself typically takes 4-5 hours. I will post an update later today, after the surgery is complete.