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PedsCrit
Norwood Part 2: Procedure & Immediate Post-Op Management with Dr. Greg Yurasek
May 29, 2023
Dr. Greg Yurasek discusses the step-by-step process of the Norwood procedure, options for blood delivery to the PA bifurcation, surgeon's decision-making process for cardiac procedures in children, immediate post-op care strategies, and managing urine output in children after surgery.
25:08
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Quick takeaways
- The Norwood procedure involves complex surgical steps and the choice of shunt depends on the surgeon's preference and experience.
- After the Norwood procedure, maintaining optimal cardiac output and oxygen delivery is crucial, requiring strategies such as fluid replacement, vasoactive medications, and close monitoring of ventilation parameters.
Deep dives
Overview of the Norwood Procedure
The Norwood procedure is a complex surgery that aims to establish unobstructed systemic outflow for infants with hypoplastic left heart syndrome. The procedure involves several surgical steps, including the creation of a neo aorta, augmentation of the hypoplastic ascending aorta and transverse arch, and coarctectomy. The surgery requires great precision due to the small size of the vessels involved and the challenges of connecting them. Surgeons typically choose between two shunt options, the Sano shunt or the BTT shunt, depending on the specific anatomy of the patient. While the Sano shunt offers short-term benefits, including improved survival, it may be associated with a higher risk of additional procedures in the long run. The choice of shunt is typically based on the surgeon's preference and experience.
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