Norwood procedure is performed for?

Appeared in: SCTIMST Staff Nurse - 2016

Explanation

The Norwood procedure is the first-stage palliative surgery for Hypoplastic Left Heart Syndrome (HLHS), a condition where the left side of the heart is severely underdeveloped.
The primary goal is to enable the single functional ventricle (the right ventricle) to pump blood to the body.
This is achieved by reconstructing the aorta (creating a 'neoaorta') and placing a shunt (e.g., Blalock-Taussig or Sano shunt) to regulate blood flow to the lungs.
It is a life-saving but palliative measure, not a curative correction, and is the first of three planned surgeries (Norwood, Glenn, Fontan).

Option A: The Norwood procedure is a palliation, not a correction. It manages single-ventricle physiology but does not create a two-ventricle circulation.
Option C: The standard surgical repair for Transposition of the Great Arteries (TGA) is the Arterial Switch Operation (Jatene procedure).
Option D: Repair of an interrupted aortic arch involves direct anastomosis (connection) of the aortic segments, which is a different procedure.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Surgical management of Hypoplastic Left Heart Syndrome (HLHS) as background academic context rather than a clinical decision trigger.
Post-Norwood nursing care is critical and focuses on maintaining the delicate balance between systemic (body) and pulmonary (lung) blood flow (Qp:Qs balance).
The target oxygen saturation (SpO2) is typically 75-85%. A higher SpO2 (e.g., above 90%) is alarming as it may indicate excessive pulmonary blood flow ('pulmonary steal'), which compromises perfusion to the body and coronary arteries.
Nurses must vigilantly monitor for signs of shunt failure. A sudden drop in SpO2 could indicate a life-threatening shunt thrombosis, while a narrowing or absent pulse pressure may suggest poor systemic output.

How to Approach the Question

First, identify the key term in the question stem: 'Norwood procedure'. This is a specific, named surgical operation.
Access your knowledge base on congenital heart surgery. The Norwood procedure is famously linked to one specific, complex lesion.
Evaluate the options based on this primary association. 'Hypoplastic left heart syndrome' is the classic indication.
Differentiate between 'palliation' and 'correction'. The Norwood is the first of a three-stage palliative pathway, not a one-time fix. This makes 'palliation' the correct term and rules out 'correction'.
Eliminate the other options by recalling the standard surgical repairs for those conditions (e.g., Arterial Switch for TGA).

Concept Tested & Keywords

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 pp. 610-612, 609-611

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