3-stage procedure to palliate single ventricle physiology (most commonly hypoplastic left heart syndrome)
Staged approach is necessary due to high pulmonary vascular resistance in neonatal period
Developed in early 1980s, initially as 2 stages
Goals of Norwood procedure
Utilize single right ventricle (RV) [or, less frequently, single left ventricle (LV)] as systemic pump & reconstruct systemic arterial outflow
Ensure unobstructed pulmonary venous return to right heart
Reroute systemic venous return directly to lungs
Stage 1 Norwood
Performed within 1st few days after birth
Neoaorta construction: Divide main pulmonary artery (PA) & anastomose to aortic root
Single, unobstructed arterial trunk from RV to systemic circulation is now in place
Blalock-Taussig (BT) or Sano shunt is created to provide blood flow to high-resistance PA circulation
Ductus arteriosus is ligated
Atrial septum is resected
Common atrium receives blood from superior & inferior vena cavae (SVC & IVC) & pulmonary veins
Stage 2 Norwood
Performed between 3-6 months of age
Pulmonary vascular resistance has ↓ by this time to normal levels
BT or Sano shunt is excised
Bidirectional Glenn shunt is created
End-to-side anastomosis of SVC to PAs
Stage 3 Norwood
Typically performed between 18-36 months of age
Lateral tunnel or extracardiac type of Fontan is now performed; atriopulmonary type is not common today
IVC blood flow is directed to PAs
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Natural History & Prognosis
Selected References
Dillman JR et al: Imaging of Fontan-associated liver disease. Pediatr Radiol. 50(11):1528-41, 2020
Vitanova K et al: Choice of shunt type for the Norwood I procedure: does it make a difference? Interact Cardiovasc Thorac Surg. 30(4):630-5, 2020
Devlin PJ et al: Intervention for arch obstruction after the Norwood procedure: prevalence, associated factors, and practice variability. J Thorac Cardiovasc Surg. 157(2):684-695.e8, 2019
Nakamura Y et al: The Norwood procedure with valvular pulmonary stenosis. Ann Thorac Surg. 107(1):e49-50, 2019
Brida M et al: Systemic right ventricle in adults with congenital heart disease: anatomic and phenotypic spectrum and current approach to management. Circulation. 137(5):508-18, 2018
Téllez L et al: Fontan-associated liver disease: a review. Ann Hepatol. 17(2):192-204, 2018
Kiraly L et al: Three-dimensional printed prototypes refine the anatomy of post-modified Norwood-1 complex aortic arch obstruction and allow presurgical simulation of the repair. Interact Cardiovasc Thorac Surg. 22(2):238-40, 2016
Kutty S et al: Role of imaging in the evaluation of single ventricle with the Fontan palliation. Heart. 102(3):174-83, 2016
Poterucha JT et al: Magnetic resonance elastography: a novel technique for the detection of hepatic fibrosis and hepatocellular carcinoma after the Fontan operation. Mayo Clin Proc. 90(7):882-94, 2015
Sandler KL et al: Optimizing CT angiography in patients with Fontan physiology: single-center experience of dual-site power injection. Clin Radiol. 69(12):e562-7, 2014
Dillman JR et al: Cardiovascular magnetic resonance imaging of hypoplastic left heart syndrome in children. Pediatr Radiol. 40(3):261-74; quiz 379-80, 2010
Related Anatomy
Loading...
Related Differential Diagnoses
Loading...
References
Tables
Tables
KEY FACTS
Terminology
Imaging
TERMINOLOGY
Definitions
3-stage procedure to palliate single ventricle physiology (most commonly hypoplastic left heart syndrome)
Staged approach is necessary due to high pulmonary vascular resistance in neonatal period
Developed in early 1980s, initially as 2 stages
Goals of Norwood procedure
Utilize single right ventricle (RV) [or, less frequently, single left ventricle (LV)] as systemic pump & reconstruct systemic arterial outflow
Ensure unobstructed pulmonary venous return to right heart
Reroute systemic venous return directly to lungs
Stage 1 Norwood
Performed within 1st few days after birth
Neoaorta construction: Divide main pulmonary artery (PA) & anastomose to aortic root
Single, unobstructed arterial trunk from RV to systemic circulation is now in place
Blalock-Taussig (BT) or Sano shunt is created to provide blood flow to high-resistance PA circulation
Ductus arteriosus is ligated
Atrial septum is resected
Common atrium receives blood from superior & inferior vena cavae (SVC & IVC) & pulmonary veins
Stage 2 Norwood
Performed between 3-6 months of age
Pulmonary vascular resistance has ↓ by this time to normal levels
BT or Sano shunt is excised
Bidirectional Glenn shunt is created
End-to-side anastomosis of SVC to PAs
Stage 3 Norwood
Typically performed between 18-36 months of age
Lateral tunnel or extracardiac type of Fontan is now performed; atriopulmonary type is not common today
IVC blood flow is directed to PAs
IMAGING
General Features
Radiographic Findings
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Natural History & Prognosis
Selected References
Dillman JR et al: Imaging of Fontan-associated liver disease. Pediatr Radiol. 50(11):1528-41, 2020
Vitanova K et al: Choice of shunt type for the Norwood I procedure: does it make a difference? Interact Cardiovasc Thorac Surg. 30(4):630-5, 2020
Devlin PJ et al: Intervention for arch obstruction after the Norwood procedure: prevalence, associated factors, and practice variability. J Thorac Cardiovasc Surg. 157(2):684-695.e8, 2019
Nakamura Y et al: The Norwood procedure with valvular pulmonary stenosis. Ann Thorac Surg. 107(1):e49-50, 2019
Brida M et al: Systemic right ventricle in adults with congenital heart disease: anatomic and phenotypic spectrum and current approach to management. Circulation. 137(5):508-18, 2018
Téllez L et al: Fontan-associated liver disease: a review. Ann Hepatol. 17(2):192-204, 2018
Kiraly L et al: Three-dimensional printed prototypes refine the anatomy of post-modified Norwood-1 complex aortic arch obstruction and allow presurgical simulation of the repair. Interact Cardiovasc Thorac Surg. 22(2):238-40, 2016
Kutty S et al: Role of imaging in the evaluation of single ventricle with the Fontan palliation. Heart. 102(3):174-83, 2016
Poterucha JT et al: Magnetic resonance elastography: a novel technique for the detection of hepatic fibrosis and hepatocellular carcinoma after the Fontan operation. Mayo Clin Proc. 90(7):882-94, 2015
Sandler KL et al: Optimizing CT angiography in patients with Fontan physiology: single-center experience of dual-site power injection. Clin Radiol. 69(12):e562-7, 2014
Dillman JR et al: Cardiovascular magnetic resonance imaging of hypoplastic left heart syndrome in children. Pediatr Radiol. 40(3):261-74; quiz 379-80, 2010
STATdx includes over 200,000 searchable images, including x-ray, CT, MR, and ultrasound images. To access all images, please log in or subscribe.