Cardiac abnormalities in children below 13 years fall in the speciality of Pediatric cardiac surgeries. Most of the defects in the heart are identified at the time of birth itself and these are called as congenital defects. At times they are big enough to cause immediate distress to the new born. In other cases they are small initially and cause symptoms when the child grows older and more active. The defective heart is unable to catch up with the activities and demands of the growing body and thus starts showing symptoms of breathlessness, bluish discoloration of the body, loss of consciousness etc. Such defects need to be corrected immediately.
The Pediatric cardiac surgery team of hospitals affiliated to Indiacarez is among the best in the world. They are a blend of experience, compassion, innovation and diligence. The team consists of the finest doctors who have trained in this field and have years of experience of dealing with such cases. They are up to date with the latest technology. They are adept at handling any complication that may come during the surgery.The OT support team, operation theatres and diagnostic facilities are excellent. The hospital provides complete care to the patient and psychological support to the caregivers which makes the whole experience less overwhelming.
The major cardiac defects include atrial septal defect, ventricular septal defect, Fallot’s tetralogy, patent ductus arteriosis, valvular defect and transposition of great vessels.
The heart is divided into two upper and two lower chambers by means of a septum that prevents mixing of pure and impure blood. In this defect the septum between the two upper chambers has a hole which causes mixing of blood. Because of this the body does not receive oxygenated blood. The person may have irregular heartbeats, bluish discoloration of the body etc.
The defect can be corrected using the traditional open heart surgery method or the latest minimally invasive method. The choice of surgery depends on the size of the defect and related complications.
In open heart surgery, the patient is fully sedated before the beginning of the procedure and attached to heart lung machine. The breast bone or sternum is cut in the middle. It is pulled apart and the surgeon accesses the major arteries and veins and clamps them. A solution paralyses the heart temporarily which allows the surgeon to stitch up the defect using dacron patch or directly sew the ends together.
Minimally invasive surgery and robotic surgeries are the latest approaches to correct this defect. The incision for minimally invasive surgery is around 2-3 inch as compared to 6-8 inch cut in the open heart approach. Minimally invasive surgery and robotic surgery to correct this defect has many advantages over the conventional approach. The size of the incision is small, cosmetically acceptable, the blood loss is less, the recovery and healing is faster which cuts down the hospital stay. Robotically assisted heart surgery is performed through a small working incision and three small incisions (ports) that are made in the spaces between the ribs (see image to the right). The surgical instruments (attached to the robotic arms) and one tiny camera are placed through these ports. Motion sensors are attached to the robotic “wrist,” so the surgeon can control the movement and placement of the surgical instruments to perform the procedure. The defect is stitched up similarly.
In minimally invasive surgery an umbrella like occlusion device is used which id guided up the femoral artery up to the defect. The device is then opened like the umbrella and the defect is sealed.Both procedures have little port operative complications.
It defect is a hole in the septum between the lower chambers of the heart. This also causes mixing of pure and impure blood between the ventricles. Slowly the patient gains weight develops fluid retention, pulmonary congestion and congestive cardiac failure. The severity of symptoms is proportional to the size of the defect. Small VSDs’ are symptomless and closed spontaneously as the child grows. The large VSDs’ cause symptoms like difficulty in breathing and feeding, poor growth and pallor. Timely surgery can help reverse the effects of the defect.
There are two types of surgery to correct a VSD:-
The surgical technique is chosen based upon the nature of the VSD and associated side effects on the patient’s heart and lungs.
a) The intra-cardiac approach is the most common technique and is done while the patient is under cardiopulmonary bypass and is an open-heart operation. This is the most widely used procedure for most children and at most pediatric surgical centers.
b) Trans-catheter technique uses surgical instruments that are passed through catheters placed in the patient’s large blood vessels into the heart. This “trans-catheter approach” is generally difficult and it is considered on select patients.
It is a congenital heart disease where the positions of two major vessels, aorta and pulmonary artery are interchanged. It is the second most common congenital heart disease seen in infants. In this defect the blood reaching the body tissues is low in oxygen; hence it is also known as cyanotic heart defect. Two separate circulation routes exist and they do not interconnect anywhere. The symptoms appear at birth and consist of cyanosis, shortness of breath, clubbing, poor feeding.
Initial surgical intervention consists of introducing a cardiac catheter into the heart to create a hole in the inter-atrial septum which allows the circulations to communicate. The defect is corrected permanently by an arterial switch procedure in which the positions of the great vessels are corrected to normal. Most infants lead normal lives after surgery and show no symptoms.
Tetralogy of Fallot is a rare condition caused by a combination of four heart defects that are present at birth. These defects, affect the structure of the heart, cause oxygen-poor blood to flow out of the heart and into the rest of the body. Infants and children with tetralogy of Fallot usually have blue-tinged skin because their blood doesn’t carry enough oxygen.
Tetralogy of Fallot involves four heart defects:
Complete Intracardiac Repair:- In this the surgeon will widen the narrowed pulmonary blood vessels. The pulmonary valve is widened or replaced. Also, the passage from the right ventricle to the pulmonary artery is enlarged which allows improve blood flow to the lungs to get enough oxygen to meet the body’s needs. Repair the (VSD). A patch is used to cover the hole in the septum. This patch stops oxygen-rich and oxygen-poor blood from mixing between the ventricles.
Temporary or Palliative Surgery:- In temporary surgery, the surgeon places a tube between a large artery branching off the aorta and the pulmonary artery. The tube is called a shunt. One end of the shunt is sewn to the artery branching off the aorta. The other end is sewn to the pulmonary artery.The shunt creates an pathway for blood to travel to the lungs to get oxygen. The surgeon removes the shunt when the baby’s heart defects are fixed during the full repair.
It is another less common congenital heart defect in which the connection that exists between the pulmonary artery and the aorta at the foetal stage does not close just before birth. The child may present with rapid breathing, increased sweating, weight loss and difficulty in feeding. Severe cases may present with congestive cardiac failure which indicates immediate surgery.
There are two types of interventions –
a) Catheter Based Closure involves inserting an occlusion device via the catheter placed in the major artery or vein in the groin. The device is guided up to the opening of the duct where the closure takes place. The patient is required to stay overnight in the hospital and discharged next day.
b) In a Traditional Surgical Closure thoracotomy (opening of ribcage) is performed and the duct is ligated at both ends with heavy sutures under direct vision. The patient is kept under observation in the ICU for 24 hours – the total hospital stay is 5 days. The child resumes normal activity after 8 weeks of surgery.
Valves allow unidirectional blood flow between the upper and lower chambers of the heart and the lower chambers and artery. Malfunction of these valves affects the flow of blood between the atria and the ventricles. The muscles of the heart work harder to push the blood out in case the valves are narrow or leaking. This may cause heart failure.
Double valve replacement is replacement of both the mitral and the aortic valve, or the left side of the heart. It is an open heart operation. This means that the surgeon opens your chest and heart to remove the damaged valve. The new artificial valve is then sewn into place.
In some cases, the valve can be replaced without opening the chest, such case is called minimally invasive surgery, the damaged valve is replaced through a small incision near the “breastbone” or under your right chest muscle.
Minimally invasive procedure and robotic surgery for valve repair is available in Indiacarez affiliate hospitals. These surgeries require small incisions between the ribs to insert the micro instruments as compared to the wide incisions in open heart technique. A catheter with a camera at the tip is inserted through the ports up to the site of defects. It provides live images of the defect and surrounding areas. It also helps to visualise and guide the instruments during the surgery. Robotic surgery gives the surgeon greater precision and wider range of movements during the surgery. Faster recovery and minimal complications have made these surgeries hugely popular.
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