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Treatment for Your Child’s Hypoplastic Ventricle: Stage I

Your child has a heart problem that includes a hypoplastic ventricle. The most common treatment is heart surgery. This is often done in three stages. Treatment is complex. It requires careful management of your child’s health. And treatment does not repair your child’s heart problem. But it can relieve symptoms and increase your child’s chances to live a more normal life. Your child’s doctor has decided that the benefits of this surgery outweigh any risks. This sheet helps you understand the surgery that is done during stage I. Your child’s cardiologist or surgeon can answer your questions and tell you more as needed.

The Goals of Heart Surgery for a Hypoplastic Ventricle

Stage I. Make the one working ventricle the main pumping chamber of the heart. This will let it send oxygen-rich blood to the body.

Stage II. Decrease the workload of the one ventricle.

Stage III. Separate the circulation of blood in the heart. This is so oxygen-poor blood and oxygen-rich blood don’t mix.

 Risks and Possible Complications of Heart Surgery Include:

• Arrhythmia (abnormal heart rhythm)

• Problems in the lungs

• Infection

• Bleeding

• Problems with the nervous system

• Abnormal buildup of fluid around the heart or lungs

Stage I: The Norwood Procedure

The first stage of surgery is called the Norwood Procedure. It is generally done within the first week after birth. A hospital stay of 3-4 weeks may be needed. Your child will need this procedure if the aorta or other left heart structures are too small or absent. This includes hypoplastic left heart syndrome. The procedure 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 procedure, the surgeon performs the following:

• Atrial septectomy. The atrial septum (wall dividing the two upper chambers) is removed. This allows oxygen-rich blood from the left atrium to mix with oxygen-poor blood in the right atrium.

• Reconstruction of aorta. The main pulmonary artery is divided. It is used, along with patch material, 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 directly to the body instead of to the lungs.

• Placement of shunt (tube). A new pathway must be created to send blood to the lungs. This is because the main pulmonary artery has been used to rebuild the aorta. So, a shunt is placed. It connects an artery branching from the aorta to the pulmonary artery. This allows a controlled amount of blood to reach the lungs. The surgeon may use a technique called the Sano method in place of the shunt. In this case, a tube is placed from the right ventricle to send blood directly to the pulmonary artery.

When to Call the Doctor

After any of these surgeries, call the doctor right away if your child has any of the following:

• Increased redness, draining, swelling, or bleeding at the incision site

• Fever 100.4°F or higher

• Trouble feeding

• Tiredness

• Shortness of breath

• Cough that won’t go away

• Nausea or vomiting

• Irregular heartbeat