What Do You Need to Know About Congenital Heart Surgery?

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Congenital heart defects are amongst the commoner birth defects and are the predominant cause of death from birth defects during the first year of life.

Congenital means inborn or existing at birth. A congenital heart defect takes place when the heart or blood vessels near the heart do not develop normally before birth. They can be further categorized into three main groups:

  1. There is narrowing inside the heart at the level of the valve or the outflow passages or in the blood vessels outside the heart. This obstructs the flow of blood and puts a strain on the heart muscles. In severe cases, the blood flow to the distant organs may be severely impaired e.g.aortic stenosis, Coarctation of aorta.
  2. There may be defects or holes in the partitioning septum between the right and left chambers of the heart. This usually results in excessive flow or shunting of blood to the lungs. e.g. VSD, ASD.
  3. The main vessels may be attached to the heart at an abnormal location e.g. d-TGA. Also, at times, the normal communication present at birth may persist between the main blood vessels, g. patent ductus arteriosus.

In some children with heart abnormalities, there are no symptoms and the disorder is only recognized when the child has an illness or during a routine examination. This is usually recognized by the presence of a murmur caused by the turbulence in the blood flow.

The more common presentation is with shortness of breath and difficulty with feeding or poor weight gain for age. Some abnormalities lead to the mixing of the blue de-saturated blood coming from the body with the bright red oxygenated blood coming from the lungs leading to the blueness of the lip and skin (called cyanosis) often accompanied with extreme irritability.

Once suspected the nature of the problem and its severity has to be determined and this will involve some tests most commonly a saturation level along with an ECG, X-RAY of the chest and an ECHO. Sometimes a cardiac catheterization, computerized tomography or MRI may be needed to decide on operability and surgical planning.

The vast majority of the cardiac defects will need intervention which will be surgical in nature to correct the underlying structural defect. Congenital heart surgeons are skilled at treating congenital heart problems for newborn, children and adults. The highly trained team provides the most advanced approaches and comprehensive care to remedy all types of repairs, even the most complex challenging and life-threatening heart condition with outstanding results.

In the operating theatre, a team including the cardiac surgeon, anesthesiologist, other physicians, perfusionist, technicians and nurses perform the heart surgery. While the surgeon operates, the anesthesiologist gives you anaesthesia and monitors the vital signs.

The team will use a heart-lung machine, which is also known as a cardiopulmonary bypass machine during open heart surgery, e.g. VSD Closure, TOF Repair. In essence what happens during the CPB is that the blue blood  which is low in oxygen is diverted to the machine before it enters the heart. If then pumps it enough an oxygenator which adds oxygen to it and then this red oxygen rich blood is pumped back into the body.

This allows the surgical team to operate in a still bloodless field while allowing blood flow to the rest of the body including the vital organs like the brain and kidneys.

Once the heart-lung machine is working, and heart is empty, the team of doctors gives medication to stop the heart from pumping. After the surgeon finishes the operation, they will close the incision in the heart. With the heart closed blood is allowed to fill the heart to remove air, and the heart is allowed to beat again. As soon as the heart is pumping normally, the team will turn off and disconnect theheart-lung machine and let the heart pump naturally.

Some operations on the blood vessels next to the heart do not need the heart-lung machine. These types of operations are called closed heart surgery. e.g. PDA, BT Shunt.

After surgery you will be shifted to the intensive care unit (ICU), specially trained doctors, nurses and technicians will give you round the clock care.

Your doctor may do blood tests, ECHO and chest x-ray to monitor your heart function. You may also receive intravenous medications to increase your blood pressure or heart rate to allow the body to get rid of extra fluid that builds up during open heart surgery. You will be kept as comfortable with pain medications and sedatives. A ventilator supports the child’s breathing. Once stability is established the support devices and medications are gradually weaned off.

After leaving the ICU, you will go to the less intensive area of the hospital which is called ‘the floor’ or ‘step-down’ unit. In this are, the heart rate and rhythm are actively monitored. You will participate in a program that encourages coughing and deep breathing to help lung prevent collapse and infection. Engaging in normal activities, like walking and going to the bathroom will help speed recovery.

When the doctors are satisfied that you are getting better, it will be time to go home. They may take a chest X-Ray, echocardiogram, electrocardiogram before they discharge you to check the results of the surgery. You may be given pain medications to take at home. The doctor will give you instructions on how and when to give these medications, be sure you understand all your medications before you leave the hospital. Your cardiologist or surgeon may stop or adjust your medications when you return for your post-operative visit.

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