Pediatric Cardiac Surgery

Listed below is the step by step procedure of pediatric cardiac surgery:

1. What is Pediatric Cardiac Surgery?
2. Why is Pediatric Cardiac Surgery Required?
3. Pre-operative Preparation
4. Day Before Surgery
5. Procedure Day
6. Methods/Techniques of Colon Cancer Surgery
7. Post Procedure
8. Risks and Complications
9. FAQs

What is Pediatric Cardiac Surgery?

Congenital heart defects are known to affect approximately 8 out of 1000 children. Congenital heart defects are developmental abnormalities in the structure of heart. This leads to deviation of heart functions from normal thereby causing symptoms to the patient. Pediatric cardiac surgery is the surgical term for depicting treatments required to treat congenital heart defects and other cardiac issues in children.

Why is Pediatric Cardiac Surgery Required?

There are many different cardiac conditions in children that come under the collective umbrella of “Pediatric Cardiac Surgery.” These conditions are such that they can be treated only with surgery. Few of them that require to be treated with surgery are as follows:

• Atrial Septal Defect (ASD)

  Left and right upper chambers of the heart are separated by the atrial septum. A hole formed in that region is known as atrial septal defect. It is a congenital defect meaning it occurs by birth. This condition causes irregular heartbeats and is treated using an open heart surgery.

• Ventricular Septal Defect (VSD)

  Left and right ventricles are separated by ventricular septum. This wall starts forming as the fetus grows in the womb. If the wall does not develop properly, a hole forms on it. This hole is known as VSD. Babies born with this defect have breathing problems among other symptoms. Cardiac catheterization is an option, but if it does not work, then cardiac surgery needs to be done.

• Tetralogy of Fallot

  This is another type of congenital heart defect. Tetralogy of Fallot gets its name from the doctor who discovered this defect in the heart. 4 defects namely - pulmonary stenosis, VSD, over-riding aorta and right ventricular hypertrophy come under the collective umbrella of Tetralogy of Fallot. This defect reduces oxygen levels in the blood, rendering a bluish tinge to the baby's skin. This defect obstructs the blood flow through the heart. Open heart surgery is required to be done and is recommended when the baby is 6 months old.

• Hypoplastic Left Heart Repair

  The left side of the heart which is made up of the left ventricle, aortic valve, mitral valve and aorta do not get developed properly when in the womb. They remain severely under-developed in this condition. This condition is largely asymptomatic and the baby may seem normal even when the left side of heart is under-developed. However, difficulty in breathing, cold hands and feet, dilated pupils in baby are few noticeable symptoms. If left untreated, the baby may lose its life in its initial few days of birth. Cardiac surgery for treating this condition consists of a series of 3 operations to restore the defect in left part of the heart or through heart transplant. The 3 series surgical procedure is preferred because searching for donor hearts that are suitable for the baby are time-consuming.

• Patent Ductus Arteriosus ligation

  This heart condition is more common among female babies more than male ones. Rapid breathing, trouble in feeding, persistent crying are few symptoms shown by babies suffering from this condition. Babies born with German measles and Down Syndrome are at a higher probability of having PDA. The ductus arteriosus is a blood vessel in a baby that closes soon after birth. When the blood vessel remains open, the condition is termed as Patent Ductus Arteriosus. The treatment for this condition is known as Patent Ductus Arteriosus ligation.

Pre-operative Preparations

Before the actual surgery commences, few pre-operative tests need to be done for your child. Electrocardiogram (EKG), complete blood count, chest X-ray, physical examination, cardiac catheterization and ultrasonography of heart are few of the test results required

Day before Surgery

• Discuss with the doctor the medicines your child could take before surgery.
• Blood thinning medication needs to be stopped prior to surgery. So if you are giving any blood thinners to your child, you need to stop that.
• You will be told the time you need to show up in the hospital for the surgery.

Procedure Day

• The child needs to be on empty stomach after midnight before the surgery day.
• Any medication the doctor has prescribed for giving before the surgery, needs to be given with water.

Methods/Techniques of Pediatric Cardiac Surgery

• Open Heart Surgery

Different cardiac conditions are treated using open heart surgery, which is considered a very major surgery of the heart. The heart is connected to a heart-lung bypass machine for stopping it. Blood is then taken out, oxygenated and then returned back to the body. The cardiac defect is located and repaired. If a defect in the heart walls is to be repaired it is either sutured together or sealed with muscle tissue taken from other body parts. The incisions are then sealed using special sutures and the heart is restarted using electrical shocks.

• Closed Heart Surgery

Closed heart surgery is a surgical option that may be required to treat cardiac issues that impede its functioning. This surgery technique does not use heart-lung bypass machine.

In closed heart surgery, heart is accessed either from near the chest or from between ribs. Closed heart surgeries deal with the symptoms instead of the defects of the heart chambers. Closed heart surgeries are not the end of the disorder, they are just one of the few multiple surgeries that are required for the correction of the exact defect. When done for treating children, they are used in conjunction with other surgeries.

Post Procedure

Children who have undergone open heart surgery for any of the above mentioned heart defects, are shifted to the Intensive Care Unit (ICU) of the hospital for the next 3 days after surgery. The child will be connected to a variety of tubes for respiratory support, emptying the bladder, intravenous line for fluids and medications etc. during its stay in the ICU.

Do's and Don'ts Post Pediatric Cardiac Surgery

• If your child undergoing surgery is an infant, then the child should be lifted very carefully for the first few weeks.
• You should keep your child from participating any activity that could put pressure on their chest for first 4 weeks after surgery. This includes skating, riding a bicycle, swimming, and all contact sports until the doctor approves.
• Do not forget to give the prescribed medicines as per dosage as instructed by doctor.
• Have a word with your doctor as to what all foods are necessary to be included in his/her diet hereafter.
• Discuss with your doctor as to when your child could return to school and also participate in various curricular activities

Risks and Complications

Any heart surgery is crucial in nature. And if it is for treating cardiac issues in children, then it is all the more important. The risks and complications of pediatric heart surgery also cannot be ignored. Few of them are as follows:

• Bleeding: Losing blood during surgery or in the period of time after surgery is a possible risk.
• Unsuitable reactions: There is every chance that the child's body may not react well to the medicines used during surgery.
• Difficulty in breathing: The child may have breathing problems post cardiac surgery.
• Infections: Infections in the heart and areas surrounding heart is possible. Although infections are a possibility only when device implants are involved in surgery.
• Stroke: Stopped blood flow to the brain is capable to produce stroke. Stroke in turn is a result of blood clots formed in blood vessels.
• Blood clots
• Air bubbles: When air bubbles enter into blood vessels, that condition is called air embolism. If they enter brain or lungs, stroke or heart attack also can happen.

FAQs

1. Can I be in the operating room with my child?

   A. No, only the operating surgeons and nurses are allowed in there.

2. Should I tell my child about the operation?

   A. Yes, you need to tell your child about the operation he/she is scheduled to undergo.

3. Should my child or a parent donate blood before the operation?

   A. If extra blood is needed, doctors will instruct you about the same.