Congenital heart defect corrective surgery
Alternative names:
ASD repair; atrial septal defect repair; coarctation of the aorta repair; heart surgery for children; hypoplastic left heart repair; patent ductus arteriosus ligation; PDA ligation; tetralogy of fallot repair; total anomalous pulmonary artery correction; transposition of great vessels repair; tricuspid atresia repair; truncus arteriosus repair; ventricular septal defect repair; VSD repair
Definition:
Surgery to correct or treat birth defects of the heart (congenital heart disease) that threaten the child's well-being or life.
Description:
Heart defects come in all types, from minor to major. Defects can occur inside the heart or in the large blood vessels outside the heart. The heart defect may need immediate surgery or may be able to safely wait for months or years. The heart defect may be repaired in a single surgical procedure or may require a series of procedures. Surgery may involve opening the heart to repair defects inside the heart or repairing defects of the blood vessels outside the heart.
An incision may be made through the breastbone (sternum) and between the lungs (mediastinum) while the child is deep asleep and pain-free (under general anesthesia). For some heart defect repairs, the incision is made on the side of the chest, between the ribs (thoracotomy) instead of through the breastbone. Heart-lung bypass may be needed. Tubes are used to re-route the blood through a special pump that adds oxygen to the blood and keeps it warm and moving through the rest of the body while the repair is being done.
Heart surgery for children requires a specialized team of pediatric heart (cardiovascular) surgeons, pediatric anesthesiologists, pediatric heart-lung bypass (cardiopulmonary bypass pump) machine technologists, pediatric surgical nurses and technicians, and pediatric intensive care physicians and nurses. Heart surgery requires intensive and extensive monitoring, treatment, and coordination by the entire team. Heart surgery for children may take from 1 to 6 hours in the operating room.
After heart surgery, the child will be moved to the Intensive Care Unit (ICU) to be constantly and closely monitored and treated for several days.
The child will have: - A tube in his airway (endotracheal tube) and a respirator helping him breathe for a day or two. He will be kept sleeping (sedated) while he needs the respirator.
- One or more small tube(s) in a vein (IV line) to give fluids and medications.
- A small tube in an artery (arterial line) to measure how well the heart is working.
- One or two tubes in his chest (chest tubes) to drain air, blood, and fluid for several days.
- A tube through the nose into in the stomach (nasogastric tube or NG tube) to empty the stomach and give medications or feedings for several days.
- A tube in the bladder to drain and measure the urine for several days.
The child may have: - Pacemaker wires in the chest in case a pacemaker is needed to keep his heartbeat and rhythm regular.
SPECIFIC HEART DEFECT SURGERIES INCLUDE:
PDA ligation - Patent ductus arteriosus is often treated immediately after birth with a medication called Indomethacin. If the ductus fails to close spontaneously or with Indomethacin, surgery is performed. A small incision is made on the left side of the chest. The ductus is either ligated (tied off) or cut.
Coarctation of the aorta repair - An incision is made on the left side of the chest. There are a few different techniques used in this repair. One approach is to remove the narrowed segment of the aorta and stitch the remaining ends together. This can usually be done in older children due to the size of the aorta. Repair in infants is usually achieved by using a subclavian flap. An incision is made in the narrowed portion of the aorta. A patch is made from a portion of the left subclavian artery to enlarge the diameter of the aorta.
ASD repair - Atrial septal defects may possibly be closed in the heart catheterization lab with two small umbrella shaped ("clamshell") devices placed on both the right and left side of the septum. The two umbrellas are attached together, closing the hole in the heart. Surgery may be necessary instead. The septum is closed using sutures or covered with a patch made of membrane or synthetic material.
VSD repair - Palliative surgery may be performed for a VSD. This consists of a banding of the pulmonary artery. This procedure is done through a small incision in the chest. A synthetic band is placed around the pulmonary artery to decrease back flow of blood and pressure on the pulmonary artery. Closure of the VSD may be necessary instead of banding. The hole may be repaired with sutures, but is usually closed with a synthetic patch.
Tetralogy of Fallot repair - This repair is done between 8 months and 3 years of age. Types of repairs may vary related to the specific defects. The ventricular septal defect is closed as described above. The pulmonary valve is opened and the thickened muscle (stenosis) is removed. A patch may be placed on the right ventricle to improve circulation to the lungs.
Transposition of the great vessels - If possible, this surgery is performed shortly after birth. The most common repair is an arterial switch. The aorta and pulmonary artery are divided. The pulmonary artery is connected to the right ventricle and the aorta is connected to the left ventricle. If this repair cannot be done immediately, the pulmonary artery is banded as a palliative measure.
Truncus arteriosus repair - If the infant exhibits severe symptoms, this repair is done in the first few months of life. If not, it may be done electively between 9 and 15 months of age. The pulmonary arteries are separated from the aortic trunk and any defects are patched. The VSD is patched. A conduit is then placed between the right ventricle and the pulmonary arteries.
Tricuspid atresia repair - Tricuspid atresia severely restricts blood flow to the lungs. Other defects may exist which can aid in the oxygenation of blood and flow to the lungs. A medication called Prostaglandin E may be given to maintain a patent ductus arteriosus (a channel to the lungs) until corrective surgery can be performed. A series of shunts and surgeries may be necessary to correct this defect. The goal of this surgery is to join either the right atrium or occasionally the right ventricle to the pulmonary artery.
Total anomalous pulmonary venous return correction - This correction may be done in the newborn period if the infant has severe symptoms. If not done immediately, it is done in the first six months of life. It is an open-heart procedure. The anomalous pulmonary veins are attached to the left atrium and any abnormal connections are closed. If a PDA is present, it is tied off.
Hypoplastic left heart repair - This is a severe heart defect that, until recently was fatal within the first few weeks of life. Only a few cardiac centers have success in treating this defect. Therefore, the parents must decide how aggressively they want the medical team to be in treating their child, knowing the chances of a good outcome are low. A complicated surgery is performed in which a single vessel is formed from the pulmonary artery and aorta to create a blood supply to the lungs and the body. At about 2 years of age, the second stage of this surgery is performed to completely bypass the tiny left ventricle. A heart transplant may also be performed to treat this condition but infant heart transplants are available only in a few areas of the country.
Indications:
The type and timing of surgical repair depends on the child's condition and the type and severity of heart defects.
In general, symptoms that indicate that surgery is needed are:
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