Pediatric cardiac surgery in India deals with the heart problem of new born, infants and children. Pediatric heart problems are usually present at birth i.e. are mostly congenital.
Pediatric heart surgery or Child heart surgery is quite different and complex than cardiac surgery in adults. The physiology and disease process in children is different from adults. Surgeries on heart and lungs among children are the most intricate of all surgeries done on the human body. This is so particularly because of small size, tissue immaturity, high energy and metabolic requirement and immunity.
The most common heart ailments in children are:
- Fallot’s tetralogy
- Ventricular Septal Defect
- Atrial Septal Defect
- Valvular defects
- Aortic stenosis
- Aortic coarctation
- Tricuspid atresia
There are various techniques to perform pediatric heart surgery, depending upon the heart defect the child is suffering from and the medical condition and age of the patient. Besides, the defects can be inside the heart or in large blood vessels outside the heart. Sometimes, one surgery may be enough to repair the defect, but sometimes a series of procedures are required to completely correct the defect.
Three different techniques are used to fix congenital heart defects in children described as below:
- Open-heart surgery is when the surgeon uses a heart-lung bypass machine. It is done under general anesthesia
- Incision is made through the breastbone (sternum)
- Tubes are used to re-route the blood through a special pump called a heart-lung bypass machine. This machine adds oxygen to the blood and keeps the blood warm and moving through the rest of the body while the surgeon is repairing the heart.
- Using the machine allows the heart to be stopped. Stopping the heart makes it possible to repair the heart muscle itself, the heart valves, or the blood vessels outside the heart. After the repair is done, the heart is started again, and the machine is removed. The breastbone and the skin incisions are then closed.
- Thoracotomy- Also known as closed heart surgery, during this type of surgery, the incision is made on the side of the chest, between the ribs. This type of surgery is done using special instruments and a camera.
- The other technique uses small tubes to be inserted in the heart through an artery in the leg. Only some heart defects can be repaired this way.
Why is the Procedure required?
If the following warning signs are found in children, it indicates that a surgery is required:
- Blue or gray skin, nail beds and lips. These symptoms indicate that there is not enough oxygen in the blood (hypoxia).
- If the child has difficulty in breathing because the lungs are “wet,” congested, or filled with fluid (heart failure).
- If there exists problems in heart rhythm (arrhythmias) or heart rate.
- If there is lack of growth and development of a child. And the child is not able to sleep and eat properly.
The child would stay in the ICU for 3-4 days after the procedure and another week or so in the hospital. The child would need about 3 or 4 more weeks at home to recover. For larger surgeries, recovery may take 6 to 8 weeks.
Pain after surgery is normal and would be controlled with medications. Most children behave differently after heart surgery- they may be irritable, clingy or cry even if they were not doing this before the surgery.
The child should not do any activity where there are chances that he/ she may fall or take a blow to chest- bicycle, skateboard riding, swimming and sports should wait for at least 4 weeks. If there has been an incision through the breast bone, they should be careful in using their arms. They should not do activities like pulling or pushing, lifting arms above the head, lifting heavy things. You should not lift the child by arms.
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