Norwood Procedure Techniques

(These techniques may or may not be used)

 

Cuff technique:

 

• It is used when the asceding aorta is at least 2.5 mm in diameter.

• Bypass is discontinued and cardioplegia (intentionally stopping cardiac activity) is infused through a sidearm on the arterial cannula. During this infusion the head vessels and distant part of the aorta are blocked by forceps.

• The arterial cannula is removed and the venous cannula is left open to drain. The ductus is divided at its meeting point with the aorta.

• The arch and the asceding aorta are cut open.

• The proximal main pulmonary artery and the aorta are connected with a cuff of homograft arterial wall.

• Some variables must be given consideration such as the enlargement of the homograft tissue. An excessively large proximal neoaorta will compress the reconstructed pulmonary artery, resulting in a central stenosis.

 

Tube technique:

 

• This is an excellent technique when the aorta is less than 2 mm in diameter.

• After the child is put in circulatory arrest the ductus is divided where it meets the descending aorta and the ascending aorta is divided where it meets the arch and the innominate artery. This helps a cut to be made on the undersurface of the arch.

• The slanted edge of the femoral vein tube graft is connected to the arch, begining at the distal end of the incision.

• The femoral vein graft is then cut to length and connected to the divided main pulmonary artery that is close to the pulmonary valve.

• A 4mm long incision is made in the right side of the homograft immediatley above the suture line just made. Then the small asceding aorta is cut open and is connected to the homograft.