Heart Surgery for Congenital ... Health Article

Surgical procedures

These procedures are performed under general anesthesia. Some require the use of a heart-lung machine, which cools the body to reduce the need for oxygen and takes over for the heart and lungs during the procedure.

ARTERIAL SWITCH. Arterial switch is performed to correct transposition of the great arteries, where the position of the pulmonary artery and the aorta are reversed. The procedure involves connecting the aorta to the left ventricle and the pulmonary artery to the right ventricle.

DAMUS-KAYE-STANSEL PROCEDURE. Transposition of the great arteries can also be corrected by the Damus-Kaye-Stansel procedure, in which the pulmonary artery is cut in two and connected to the ascending aorta and right ventricle.

FONTAN PROCEDURE. For tricuspid atresia and pulmonary atresia, the Fontan procedure connects the right atrium to the pulmonary artery directly or with a conduit, and the atrial defect is closed. Survival is over 90%.

PULMONARY ARTERY BANDING. Pulmonary artery banding is narrowing the pulmonary artery with a band to reduce blood flow and pressure in the lungs. It is used for ventricular septal defect, atrioventricular canal defect, and tricuspid atresia. Later, the band can be removed and the defect corrected with open heart surgery.

ROSS PROCEDURE. To correct aortic stenosis, the Ross procedure grafts the pulmonary artery to the aorta.

SHUNT PROCEDURE. For Tetralogy of Fallot, tricuspid atresia, or pulmonary atresia, the shunt procedure creates a passage between blood vessels, sending blood into parts of the body that need it.

VENOUS SWITCH. For transposition of the great arteries, venous switch creates a tunnel inside the atria to re-direct oxygen-rich blood to the right ventricle and aorta and venous blood to the left ventricle and pulmonary artery.

OTHER TYPES OF SURGERY. These surgical procedures are also used to treat common congenital heart defects. A medium to large ventricular or atrial septal defect can be closed by suturing it or covering it with a Dacron patch. For patent ductus arteriosus, surgery consists of dividing the ductus into two and tying off the ends. If performed within the patient's first few years, there is practically no risk associated with this operation. Surgery for coarctation of the aorta involves opening the chest wall, removing the defect, and reconnecting the ends of the aorta. If the defect is too long to be reconnected, a Dacron graft is used to replace the missing piece. In uncomplicated cases, the risk of the operation is 1–2%.

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.

BOOKS

"Congenital Heart Disease." In Current Medical Diagnosis and Treatment, 1998. 37th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1997.

DeBakey, Michael E., and Antonio M. Gotto Jr. "Congenital Abnormalities of the Heart." In The New Living Heart. Holbrook, MA: Adams Media Corporation, 1997.

Park, Myung K. Pediatric Cardiology for Practitioners. 3rd ed. St. Louis: Mosby, 1996.

Texas Heart Institute. "Congenital Heart Disease." In Texas Heart Institute Heart Owners Handbook. New York: John Wiley & Sons, 1996.