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Definition

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 wellbeing.

Description

There are many kinds of heart defects. Some are minor, and others are more serious. Defects can occur inside the heart or in the large blood vessels outside the heart. Some heart defects may need surgery right after the baby is born. For others, your child may be able to safely wait for weeks, months or years to have surgery.

One surgery may be enough to repair the heart defect, but sometimes a series of procedures is needed. Three 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. In most cases, a heart-lung bypass machine is not needed with this approach. Not all heart defects are able to be treated with this approach.

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. This is called a cardiac catheterization. Only some heart defects can be repaired this way.

A related topic is congenital heart defect corrective surgeries.

Why the Procedure Is Performed

Some heart defects need repair soon after birth. For others, it is better to wait weeks, 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

Hospitals and medical centers that perform heart surgery on children have surgeons, nurses, and technicians who are specially trained to perform these surgeries. They also have staff that will take care of your child after surgery.

Risks for any surgery are:

• Bleeding during surgery or in the days after surgery
• Bad reactions to medicines
• Problems breathing
• Infection
• Death

Additional risks of heart surgery are:

• Blood clots (thrombi)
• Air bubbles (air emboli)
• Pneumonia
• Heartbeat problems (arrhythmias)
• Heart attack
• Stroke

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 (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 aspirin, 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. More complex heart surgery may require your child to stay in hospital for weeks or months after 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 amount of urine for several days.
• Many electrical lines and tubes are used to monitor the child.

By the time your child leaves the ICU, most of the tubes and wires will have been removed. Your child will be encouraged to start many of their regular daily activities. Some children may begin eating or drinking on their own within 1 or 2 days, but others may take longer.

When your child is discharged from the hospital, parents and caregivers are taught what activities are OK for their child to do, how to care for the incision(s), and how to give medicines their child may need.

Your child often needs at least several more weeks at home to recover. Talk with your provider about when your child can return to school or daycare.

Your child will need follow-up visits with a cardiologist (heart doctor), often every 6 to 12 months. Your child may need to take antibiotics before going to the dentist for teeth cleaning or other dental procedures, to prevent serious heart infections. Ask the cardiologist if this is necessary.

Outlook (Prognosis)

The outcome of heart surgery depends on the child's condition, the type of defect, and the type of surgery that was done. Many children recover completely and lead normal, active lives.

References

Douglas WI, Beers K. Technical considerations in pediatric cardiac surgery. Semin Pediatr Surg. 2021;30(2):151043. PMID: 33992311 pubmed.ncbi.nlm.nih.gov/33992311/.

Ginther RM, Forbess JM. Pediatric cardiopulmonary bypass. In: Zimmerman JJ, Clark RSB, Furhman BP, eds. Fuhrman and Zimmerman's Pediatric Critical Care. 6th ed. Philadelphia, PA: Elsevier; 2022:chap 35.

Krajewski ML, Mahmood F. Perioperative echocardiography. In: Gropper MA, ed. Miller's Anesthesia. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 37.

LeRoy S, Elixson EM, O'Brien P, et al. Recommendations for preparing children and adolescents for invasive cardiac procedures: a statement from the American Heart Association Pediatric Nursing Subcommittee of the Council on Cardiovascular Nursing in collaboration with the Council on Cardiovascular Diseases of the Young. Circulation. 2003;108(20):2550-2564. PMID: 14623793 pubmed.ncbi.nlm.nih.gov/14623793/.

Valente AM, Dorfman AL, Babu-Narayan SV, Krieger EV. Congenital heart disease in the adolescent and adult. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 82.

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