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Pediatric Cardiac Surgery

Interventional Pediatric Cardiology has come of age as therapeutic and palliative form of treatment. Now, Hybrid treatment (combined interventional and surgery) is further changing the outlook for children with heart disease. Treatment without surgery i.e. interventional catheter based treatment has helped several thousand children around the world. The most common conditions under pediatric cardiac surgery include:

1] Atrial Septal Defect (ASD):

It is a congenital defect in the heart in which the wall that separates the upper heart chambers (atria) does not close completely. Normally it is not a common ailment found in babies.However, when present, symptoms may begin any time after birth through childhood. Some of the common symptoms include difficulty in breathing, recurrent respiratory problems,and shortness of breath with activity. Babies experiencing few or no symptoms might not require an elaborate treatment. However, a surgical closure is recommended in cases of large defect, swollen heart and recurrent symptoms. Typically, the surgery involves a placement of an ASD device into the heart through catheters, which is inserted by making a tiny incision in the groin area.

2] Ventricular Septal Defect (VSD):

It is one of the most common congenital heart defects at the time of birth. It is described as one or more holes in the wall that separates the right and left ventricle of the heart. During pre-natal stages, the rightand left ventricle of the heart. During pre-natal stages, the rightand left ventricles of a heart are not separate.As the fetus grows, a wall is formed to separate these two ventricles. If the wall does not form completely, a hole remains. The most common symptoms include inconsistent breathing, paleness of skin, failure to gain weight, fast heart rate, unexpected sweating and frequent respiratory problems. Babies experiencing few or no symptoms might not require an elaborate treatment. Cases with medium severity can be treated with the help of medications. However, in severe cases a surgery is conducted to close the defect with a patch. In few cases VSDs can also be closed with a special device, which is inserted by cardiac catheterization.

3] Tetralogy of Fallot (ToF):

It is a congenital heart defect, which describes a constellation of four abnormalities, resulting in insufficient oxygen in the blood. Due to the lack of oxygen content, the primarily symptom is the bluish-purple coloration of the skin.In addition, the infant suffers from shortness in breadth, clubbing of fingers, poor feeding habits, poor development and failure to gain weight. Typically, the four related heart defects are: VSD (hole in the heart), narrowing of the pulmonary valve, overriding aorta coming out of the left ventricular pump, and a thickened muscular wall of the right ventricle commonly known as right ventricular hypertrophy. A surgery is required to restore these defects normally when the infant is young. At times, more than one surgery is required.

4] Patent Ductus Arteriosus (PDA):

It is a defect found in infants in which the blood vessel called the ductus arteriosus fails to close normally soon after birth. This conditions leads to abnormal blood flow between the pulmonary artery and aorta, which takes the blood from the heart to the lungs and to the rest of the body, respectively.Typical symptoms include difficulty in breathing, irregular heart rate & inconsistent sleeping patterns. The infant suffering from PDA is typically taken into a surgery under general anesthesia. An incision is made under the chest through which tubes are inserted to regulate the flow of blood supply.

5] Transposition of Great Arteries (TGA):

It is a congenital heart defect in which the position of pulmonary artery and aorta is switched or transposed. This defect leads to bluish-puple coloration to the skin and shortness of breadth because of the insufficient oxygen in the blood. The infant undergoes a surgery called as cardiac catheterization (balloon atrial septosomy – BAS) that can help create a bigger hole in the atrial septum to allow proper mixing of blood. A permament treatment options is an Arterial Switch Operation, which is normally performed during the first week of the birth.

6] Pulmonary Atresia:

It is one of the extreme forms of congenital heart disease which leads to a defective formation of the pulmonary valve – an opening on the right side of the heart regulating the flow of blood from the right ventricle to the lungs. This defect may or may not occur along with VSD – a condition known as pulmonary atresia with intact ventricular septum (PA/IVS). If an infant has both the problems, then the condition is termed as pulmonary atresia with VSD, which is an extreme form of ToF. Typical symptoms include bluish coloration of skin, inconsistent breathing, weariness, and irregular eating habits. An infant diagnosed with this defect immediately underwent a treatment of a medicine called Prostaglandin E1, which helps the blood move (circulate) into the lungs. A permanent procedure called as Shunt Operation can be performed where in an artificial tube is inserted between the pulmonary artery and the aorta.

7] Total Anomalous Pulmonary Venous Return (TAPVR):

It is a congenital heart disease in which none of the four pulmonary veins, which bring the oxygenated blood from the lungs to the heart, is attached to the left ventricle. In such a defect the oxygenated blood travels in a circular motion between right atrium and lungs, and never gets out of the body. Typical symptoms include weariness, poor feeding, irregular breathing, poor growth, and bluish-discoloration of skin. During the early days this defect may be asymptomatic. An early open surgery is performed to connect the pulmonary veins to left atrium.

8] Double Outlet Right Ventricle (DORV):

It is a cardiac birth defect in which the aorta, instead of rising from the left ventricle, comes out from right ventricle. Aorta is the primary blood vessel that takes the oxygenated blood from the heart and circulates to the rest of the body. Right ventricle is the chamber that collects the deoxygenated blood and sends to the lungs.Due to such a defect, the aorta, instead of carrying the oxygenated blood carries the deoxygenated blood to the rest of the body. Normally, this defect is supplemented with a VSD. This defect requires a surgical intervention. However, the number of surgeries may depend upon the type and severity of DORV.

Source: PubMed Health

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