HEART OPERATIONS IN CHILDREN: WHAT U NEED TO KNOW?
KNOW ABOUT YOUR HEART
The heart is an organ which pumps blood to various parts of
the body. The human heart consists of four chambers: right
and left atria and right and left ventricles. The two atria act
as collecting reservoirs for blood returning to the heart while
the two ventricles act as pumps to eject the blood to the
body. As in any pumping system, the heart comes complete
with valves to prevent the back flow of blood. Deoxygenated
blood returns to the heart via the major veins (superior and
inferior vena cava), enters the right atrium, passes into the
right ventricle, and from there is ejected to the pulmonary
artery on the way to the lungs. Oxygenated blood returning
from the lungs enters the left atrium via the pulmonary veins,
passes into the left ventricle, and is then ejected to the
aorta.
.
WHAT IS CARDIAC SURGERY?
Cardiac surgery is a surgery on the heart and/or great
vessels performed by a cardiac surgeon. Heart surgery is
done for a variety of reasons and ranges from minimally
invasive procedures to actually removing the heart and
replacing it with a donor heart. Frequently, it is done to treat
complications of heart.
Types of Heart Surgeries
The common
procedures which are performed
on the heart can be grouped into several categories :
-Closures
-Shunts
-Atrial Baffles
-Relief of Stenosis -PA Banding
-Conduits
-Relief of Cyanosis
Type
Procedure
Defects Treated

Reduced pulmonary blood
Description
Classic: Anastomosis of
BlalockShunts
Taussig
flow (TOF, 
TGA, pulmonary subclavian artery to PA (with
atresia, tricuspid atresia)
or without modification)
TGA (early palliation),
Atrial
Surgical atrial
mixing
septostomy
Also called Blalock-Hanlon
mitral atresia, complex
procedure
congenital heart disease
Percutaneous atrial
Balloon atrial
TGA, tricuspid atresia
septostomy, also called
septostomy
Rashkind balloon procedure
Closures
Atrial septal
ASD with significant shunt Primary or patch closure
defect (ASD)
Percutaneous closure
closure
Ventricular
Isolated VSD or with other
septal defect
(VSD) closure
Primary or patch closure
anomalies (TOF)
Patent ductus
arteriosus
Ligation ± division of PDA
Patent ductus arteriosus
Transcatheter technique
(PDA) ligation
Closure of ASD and VSD,
Endocardial
Endocardial cushion defect
repair of atrioventricular valve
cushion defect (also called atrioventricular
abnormalities (e.g., cleft
repair
canal defect)
mitral leaflet)
Surgical
PA
reduction in
Large left-to-right shunt
PA band to decrease PA flow
banding
flow area of
lesions
and pressure
TGA (replaced by arterial
Dacron or pericardial baffle
PA
Atrial
Mustard
baffles
switch procedures at many directs systemic venous return
centers)
to PA via anatomic LV,
pulmonary venous return to
aorta via anatomic RV
TGA (replaced by arterial
RA free wall and interatrial
switch procedures at many
septal tissue used for
Senning
centers). May be used as
interatrial baffle similar to a
part of “double switch”
Mustard repair.
procedure for L-TGA
Various procedures including
Aortic
end-to-end anastomosis, patch
Relief of
coarctation
Aortic coarctation
enlargement, Gore-Tex graft;
stenosis
repair
balloon dilation for
recoarctation
Pulmonic
TOF, pulmonic stenosis
Brock trans-RV approach
valvotomy
Direct surgical repair
Balloon dilation
Aortic
Direct surgical valvotomy or
Congenital aortic stenosis
valvotomy
percutaneous balloon dilation
Surgical commissurotomy—
Mitral repair
Congenital mitral stenosis
initially a “closed” procedure
without cardiopulmonary
Open heart surgery
Open heart surgery is any surgery where the chest is
opened and surgery is performed on the heart muscle, valves,
arteries, or other heart structures (such as the aorta). The
term "open" means that the chest is "cut" open .
Most
heart
surgery
is
performed
under
general
anesthesia, requiring that the patient be intubated and put on
a ventilator(artificial breathing machine). Some less invasive
procedures, such as placing stents or a pacemaker, may be
performed with monitored anesthesia care, known as twilight
sleep.
CARDIOPULMONARY BYPASS
A heart-lung machine (also called cardiopulmonary bypass) is usually
used during open heart surgery. While the surgeon works on the heart,
the machine helps provide oxygen-rich blood to the brain and other vital
organs.
HOW THE CHEST IS OPENED DURING CARDIAC SURGERY?

The heart surgeon will make a 2-inch to 5-inch-long surgical cut
in the chest wall. Muscles in the area will be divided so the
surgeon can reach the heart. The surgeon can repair or replace a
valve or perform bypass surgery.

During endoscopic surgery, the surgeon makes one to four small
holes in the chest. Then he uses special instruments and a camera
to perform the surgery.

During robot-assisted valve surgery, the surgeon makes two to
four tiny cuts (about 1/2 inch to 3/4 inch) in the chest. The
surgeon uses a special computer to control robotic arms during the
surgery. The surgeon sees a three-dimensional view of the surgery
on the computer. This method is very precise.
Closed Heart Surgery
Closed heart surgery implies that the "heart lung machine" or "bypass"
machine is not used and the heart is visualized but not cut open. Listed
below are details of three types of closed heart surgery:
Closed Heart Surgery

Patent Ductus Arteriosus

Coarctation of the Aorta

Blalock-Taussig Shunt
Patent Ductus Arteriosus (PDA)
PDA refers to an open vessel that allows blood to flow between the
aorta and the pulmonary artery. The ductus arteriosus is open during
fetal life to divert blood away from the unused lungs. Normally the
ductus closes within the first day of life, but for unknown reasons it
sometimes remains open. This occurrence is more common in premature
infants. If the PDA is small, there may be no symptoms at all.
Symptoms of a large PDA are rapid breathing, fatigue, and slow weight
gain. After surgical correction, these symptoms will disappear. The
surgery involves a left thoracotomy incision. The vessel is "ligated" and
divided in half or clipped so that there will be no flow. This is a
curative operation; no other surgery is required.
WHEN IS PDA LIGATED?
Usually PDA is closed without surgery by device closure. There are only
3 scenarios where PDA is operated:
1.Premature babies with large PDA and developing heart failure
2. PDA with infective endocarditis
3. Large PDA in babies <5kg causing recurrent chest infections or poor
weight gain
Coarctation of the Aorta
Coarctation of the Aorta is a obstruction/narrowing of the aorta.
It
may present itself as early as birth or in late childhood. The signs are
usually high blood pressure, or a higher blood pressure in the arms than
in the legs. Older children sometimes complain of leg cramps. Surgery
to correct this will equalize the blood pressure in the upper and lower
extremities.
The surgery involves opening the chest through a left
thoracotomy incision, removing the narrowed portion of the aorta, and
reattaching the two ends of the aorta together. This is also a curative
operation.
Blalock-Taussig Shunt
A Blalock-Taussig Shunt or "BT Shunt" is used to help increase blood
flow to the lungs in babies born with defects that obstruct blood flow to
the lungs. The surgery entails opening the chest either through a left
or a right thoracotomy approach and placing a Gore-Tex tube form the
innominate artery to the pulmonary artery.
This is a palliative
procedure, meaning that in most cases the final repair will be done at a
later date.
Can a child lead normal life after
cardiac surgery?
In general, problems that can be corrected without the use of heart-lung
bypass support may involve a shorter hospitalization and recovery time. Clearly,
the length of recovery will depend partly on potential complications that may
arise and partly on the health of the patient before surgery. A 6-8 week
recovery period is not uncommon. Nutrition is a critical component of this
recovery
Postoperative
period
child
as
well.
in
ICU
After surgery, most infants can be fed enterally (in the gut) after a day or
two. But even when the child is not being fed formula or milk, nutrition is being
delivered in an intravenous form. In more limited situations, simple "IV" fluids
containing sugar-water will suffice. At other times, the IV nutrition can
replace all the sugars, proteins and fats that the patient needs. That complex
form of IV nutrition is called TPN (Total Parenteral Nutrition).
Some babies can take a while to recover after surgery until they can be fed
by mouth. This partly depends on how the child was feeding before surgery
and whether there are any medical reasons affecting the ability of the gut to
work. It is not unusual for even some kids who have been feeding normally
before surgery to have a setback. They might require some sort of extra
nutritional support. Nutrition is critical in the healing process. At times we
place tubes, called feeding tubes, into the stomach (through the mouth or the
nose) to make sure your child receives adequate calories to heal properly.
Often children are discharged home on some medications. Typically these
include diuretics (water-pills) and sometimes other heart medications. The
dosage of these medications will be adjusted when you follow up with your
surgeon and cardiologist. Most patients are seen within a week to two weeks
after discharge. We will provide you with a set of instructions before your
discharge to guide you on your child's medicines and postoperative care. We
will teach you how to assess the wounds and what problems to look for.
Sick people should not visit for the first few days. Good and frequent hand
washing is critical, especially before examining the wound. The wound should be
kept clean and dry for the first couple of weeks. Generally avoid immunization
within
the
first
6-8
weeks
after
surgery.
Finally, as with any surgical incision, a rest period helps ensure good wound
healing. There will be a period of time when activity will be somewhat
restricted to help with healing.