Precautions

There are many types of surgery for congenital heart defects and many considerations in the decision to operate. The patient's cardiologist or surgeon will discuss these issues on an individual basis.

Description

There are many types of congenital heart defects. Most obstruct the flow of blood in the heart, or the vessels near it, or cause an abnormal flow of blood through the heart. Rarer types include newborns born with one ventricle, one side of the heart that is not completely formed, or the pulmonary artery and the aorta coming out of the same ventricle. Most congenital heart defects require surgery during infancy or childhood. Recommended ages for surgery for the most common congenital heart defects are:

• atrial septal defects: during the preschool years
• patent ductus arteriosus: between ages one and two
• coarctation of the aorta: in infancy, if it's symptomatic, at age four otherwise
• tetralogy of Fallot: age varies, depending on the patient's signs and symptoms
• transposition of the great arteries: often in the first weeks after birth, but before the patient is 12 months old

Surgical procedures seek to repair the defect as much as possible and restore circulation to as close to normal as possible. Sometimes, multiple, serial, surgical procedures are necessary. Smaller congenital heart defects can now be repaired in a cardiac catheterization lab instead of an operating room. Catheterization procedures include balloon atrial septostomy and balloon valvuloplasty. Surgical procedures include arterial switch, Damus-Kaye-Stansel procedure, Fontan procedure, Ross procedure, shunt procedure, and venous switch or intra-atrial baffle.

Preparation

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 shows the heart's activity and may reveal a lack of oxygen. Electrodes covered with conducting 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.

Aftercare

After heart surgery for congenital defects, the patient goes to an intensive care 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 are stable. Heart sounds, oxygenation, and the electrocardiogram are monitored. Chest tubes will be checked to ensure that they're draining properly and there is no hemorrhage. 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.

Risks

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.

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