Before jumping into the details of the correct ways to execute a pediatric cardiac surgery, it is important to fully comprehend what we are dealing with. Breaking down this operation into three words, the meaning becomes clear. “Pediatric” means the branch of study in medicine that deals with diseases and medical problems of babies, infants, teenagers, and adolescents from the time of birth to the age of 18[i]. “Cardiac” refers to anything related to the heart. And surgery, well, obviously is the physical act of removing, fixing, or treating the body’s organs and tissues. So, Pediatric cardiac surgery is a procedure that is performed on the heart of a child who are born with a defect.
What heart conditions does pediatric cardiac surgery treat?
Pediatric cardiac surgery is a tricky field, since the conditions might be simple or complex. Anything that causes symptoms requires surgery. So the congenital heart diseases in children that require treatment are usually abnormal connections between the pulmonary circulation (to and from lungs) and the systemic circulation (to and from the rest of the body), called a cardiac shunt.
- Right to left shunt
- Tetralogy of Fallot: In this condition, there are four defects in the heart.
- Transposition of the Great Arteries (TGA): The Aorta, which is supposed to rise from the left chamber, rises from the right. Pulmonary arteries arise from the left ventricle instead of the right
- Left to Right Shunt
- Ventricular Septal Defect (VSD): If there is a hole between the walls of the lower chambers of the heart, (left and right ventricles), it is called VSD.
- Atrial Septal Defect (ASD): The wall between the right and left atria (upper chambers) of the heart is called the atrial septum and if there is a hole in it, it is called an ASD[ii].
- Patent Ductus arteriosis (PDA): Before birth, the baby has a blood vessel that runs between the main artery to the body (aorta) and the main artery to the lungs (pulmonary artery) called the ductus arteriosus. This small vessel is supposed to close after birth but in this condition, it doesn’t. (2)
- Atrioventricular defect (AVSD): It is a heart condition in which, there are gaps/holes between the chambers on the left and right sides of the heart, and the valves may not be properly formed to regulate the flow of blood between these chambers.
Recapping the events:
It is crucial to understand the condition of the child first, and then offer corrective surgery at the appropriate age of the patient. This must be done by consulting a good pediatrician. Whatever is suggested, must be followed as they are sure to know what is best for the child! There is going to be an evaluation which might include: blood work, chest X-ray, an ECG (electrocardiogram), and maybe a cardiac catheterization. The blood group of the child is noted and the availability of it is confirmed[iii].
What kind of treatments do pediatric heart surgeons provide?
Since these conditions are usually caused by birth, they require urgent attention and a proper diagnosis. Most of the surgeries performed by pediatricians are known as corrective surgeries. Some of these are described below for the sake of a better understanding of the complex heart procedures:
- Open heart surgery: When a surgeon uses a heart-lung bypass device, it is called open-heart surgery. A small cut is made in the breast bone and tubes are used to re-route the blood flow. After the heart muscle is repaired, the hole is closed[iv].
- Corrective Surgeries: (2)
- PDA ligation: Small cut is made and PDA is located. It is tied off.
- Coarctation of the aorta repair: A small cut is made and made bigger with the help of synthetic material.
- Hypoplastic Left Heart repair: One blood vessel is made from the aorta and the pulmonary artery and it is a very complicated operation.
Besides these mentioned surgeries, there are other kinds of corrective surgeries that are specific to the heart defect.
Children who are born with a heart defect only live to see their condition worsen with time, as the complications of the heart become more intense. This is why pediatricians prefer to select an appropriate time and age for their surgeries. To ease their pain and to help children live a happier, healthier life is their main goal. These surgeries help in achieving a good quality of life and have a relatively quick recovery rate as well.
After heart surgery, bleeding is probably a common risk. Bleeding can also occur when surgeons have inserted sutures because of the use of a blood thinner (such as heparin) during bypass. However, it is a controllable issue, so it shouldn’t be a big problem[v]. Infections can also occur, and most of them happen around the area of surgery[vi]. There can also be allergic reactions to medicines.
Qualification of a pediatric surgeon:
Trusting a doctor for a major heart operation is a very sensitive matter and the concern of the parents or the guardians is justified. Like all other surgeons, a pediatrician should first complete his MBBS. The program is long and hectic, but it prepares one for dealing with medical problems correctly. It should be followed by a residency in general surgery which teaches the medical graduate about comparatively wider varieties of surgeries. For a surgeon to specialize in pediatric surgery, he/she would need to complete a longer session of training to excel in this line of the field.
The surgery itself is a very frightening word, so when one considers an extensive and complicated procedure being performed on a mere child, it is normal to be anxious. As stated above, most heart surgeries are just corrective procedures, which are not only very successful but also have an almost zero percent rate of mortality. The best thing a patient can do is to consult a pediatrician who is best known for his work in cardiac surgery, and to follow all instructions, the right way!