Heart surgery for congenital defects
A variety of surgical procedures can be performed to repair the many types ofheart defects that may be present at birth (congenital defects). Heart surgery is done to correct such defects to the greatest extent possible and to improve the flow of blood and oxygen to the body. While congenital heart defectsvary in their severity, most require surgery.
Surgery is recommended for defects that result in a lack of oxygen, a poor quality of life, or a child who does not gain sufficient weight. Some types ofcongenital heart defects that cause no symptoms are nonetheless treated surgically because they can lead to serious complications.
There are many types of congenital heart defects. Most obstruct the flow of blood in the heart, or the vessels near it, or cause abnormal blood flow through the heart. Rarer types include newborns born with one ventricle, one sideof the heart that is not completely formed, or the pulmonary artery and the aorta coming out of the same ventricle. Most congenital heart defects requiresurgery during infancy or childhood. Sometimes, multiple surgical proceduresare necessary.
These procedures are performed under general anesthesia. Some requirethe use of a heart-lung machine, which cools the body to reduce the need for oxygen and takes over for the heart and lungs during the procedure.
Before surgery for congenital heart defects, the patient will receive a complete evaluation, which includes a physical exam, a detailed family history, a chest x ray, an electrocardiogram, an echocardiogram, and usually cardiac catheterization. For six to eight hours before the surgery, the patient cannot eat or drink anything. An electrocardiogram showsthe heart's activity and may reveal a lack of oxygen. Electrodes covered withconducting jelly are placed on the patient's chest, arms, and legs and the heart's impulses are traced on paper. An echocardiogram uses sound waves to create an image of the heart's chambers and valves. Gel is applied to a hand-held transducer and then pressed against the patient's chest. Cardiac catheterization is an invasive diagnostic technique used to evaluate the heart, in which a long tube is inserted into a blood vessel and guided into the heart. A contrast solution is injected to make the heart visible on x rays.
After heart surgery for congenital defects, the patient goes to an intensivecare ward where he or she is connected to a variety of tubes and monitors, including a ventilator. Patients are monitored every 15 minutes until vital signs (pulse and breathing rate, for example) are stable. Heart sounds, oxygenation of the blood, and the electrocardiogram are monitored. Chest tubes will be checked to ensure that they are draining properly and there is no bleeding.Pain medications will be administered. Complications such as stroke, lung blood clots, and reduced blood flow to the kidneys will be watched for. After the ventilator and breathing tube are removed, chest physical therapy and exercises to improve circulation will be started.
Complications from heart surgery for congenital defects can be severe. They include shock, congestive heart failure, lack of oxygen or too much carbon dioxide in the blood, irregular heartbeat, stroke, infection, kidney damage, lung blood clot, low blood pressure, hemorrhage, cardiac arrest, and death.
Smaller congenital heart defects can now be repaired in a cardiac catheterization lab instead of an operating room. Cardiac catheterization procedures cansave the lives of critically ill newborns and in some cases eliminate or delay more invasive surgical procedures. It is expected that catheterization procedures will continue to replace more types of surgery for congenital heart defects in the future. A thin tube called a catheter is inserted into an artery or vein in the leg, groin, or arm and threaded into the area of the heart which needs repair. The patient receives a local anesthetic at the insertion site and is awake but sedated during the procedure.