Heart surgery in children is done to repair heart defects a child is born with (congenital heart defects) and heart diseases a child gets after birth that need surgery. The surgery is needed for the child’s well being.
There are several sorts of heart defects. Some are minor, and others area unit additional serious. Defects will occur within the center or within the large blood vessels outside the heart. Some heart defects might have surgery right when the baby is born. For others, your kid could also be ready to safely wait for months or years to have surgery.
One surgery could also be enough to repair the heart defect, but typically a series of procedures is required. 3 completely different techniques for fixing congenital defects of the heart in children are described below.
Open-heart surgery is when the surgeon uses a heart-lung bypass machine.
- An incision is made through the breastbone (sternum) while the child is under general anesthesia (the child is asleep and pain free).
- 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 incision are then closed.
For some heart defect repairs, the incision is made on the side of the chest, between the ribs. This is called a thoracotomy. It is sometimes called closed-heart surgery. This surgery may be done using special instruments and a camera.
Another way to fix defects in the heart is to insert small tubes into an artery in the leg and pass them up to the heart. Only some heart defects can be repaired this way.
Why the Procedure is Performed
Some heart defects need repair soon after birth. For others, it is better to wait months or years. Certain heart defects may not need to be repaired.
In general, symptoms that indicate that surgery is needed are:
- Blue or gray skin, lips, and nail beds (cyanosis). These symptoms mean there is not enough oxygen in the blood (hypoxia).
- Difficulty breathing because the lungs are “wet,” congested, or filled with fluid (heart failure).
- Problems with heart rate or heart rhythm (arrhythmias).
- Poor feeding or sleeping, and lack of growth and development of the child.
Risks for any surgery are:
- Bleeding during surgery or in the days after surgery
- Bad reactions to medicines
- Problems breathing
Additional risks of heart surgery are:
- Blood clots (thrombi)
- Air bubbles (air emboli)
- Heartbeat problems (arrhythmias)
- Heart attack
Before the Procedure
If your child is talking, tell them about the surgery. If you have a preschool-aged child, tell them the day before what will happen. Say, for example, “We are going to the hospital to stay for a few days. The doctor is going to do an operation on your heart to make it work better.”
If your child is older, start talking about the procedure 1 week before the surgery. You should involve the child’s life specialist (someone who helps children and their families during times like major surgery) and show the child the hospital and surgical areas.
Your child may need many different tests:
- Blood tests (complete blood count, electrolytes, clotting factors, and “cross match”)
- X-rays of the chest
- Electrocardiogram (EKG, or ECG)
- Echocardiogram (ECHO, or ultrasound of the heart)
- Cardiac catheterization
- History and physical
Always tell your child’s health care provider what medicines your child is taking. Include drugs, herbs, and vitamins you bought without a prescription.
During the days before the surgery:
- If your child is taking blood thinners (drugs that make it hard for blood to clot), such as warfarin (Coumadin) or heparin, talk with your child’s provider about when to stop giving these drugs to the child.
- Ask which drugs the child should still take on the day of the surgery.
On the day of the surgery:
- Your child will most often be asked not to drink or eat anything after midnight the night before the surgery.
- Give your child any drugs you have been told to give with a small sip of water.
- You will be told when to arrive at the hospital.
After the Procedure
Most children who have open-heart surgery need to stay in the intensive care unit (ICU) for 2 to 4 days right after surgery. They most often stay in the hospital for 5 to 7 more days after they leave the ICU. Stays in the intensive care unit and the hospital are often shorter for people who have closed-heart surgery.
During their time in the ICU, your child will have:
- A tube in the airway (endotracheal tube) and a respirator to help with breathing. Your child will be kept sleeping (sedated) while on the respirator.
- One or more small tubes in a vein (IV line) to give fluids and medicines.
- A small tube in an artery (arterial line).
- One or 2 chest tubes to drain air, blood, and fluid from the chest cavity.
- A tube through the nose into the stomach (nasogastric tube) to empty the stomach and deliver medicines and feedings for several days.
- A tube in the bladder to drain and measure the urine for several days.
- Many electrical lines and tubes used to monitor the child.
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