Pediatric Cardiac Surgeries

Introduction

Pediatric cardiac surgery is a complex intervention established for the newborn, all the way up to the adolescent with congenital heart disease. These surgical interventions relieve congenital heart diseases (CHD) or acquired heart diseases, restoring normal cardiac function and enhancing quality of life. Atrial septal defect (ASD), ventricular septal defect (VSD), tetralogy of Fallot (TOF) and coarctation of the aorta are some common known congenital heart defects.

Improvements in medical technology and surgical procedures allow pediatric cardiothoracic surgery to be safely and effectively performed in the majority (if not all) of cases, bringing new hope to families worldwide. India, owing to its high-quality hospitals and specialized, accomplished surgeons of the pediatric cardiac field, has evolved into a typical solution for less expensive advanced medical care at all levels in the world.

What are Pediatric Cardiac Surgeries?

Pediatric cardiac surgery is a specialty of surgery that corrects defects or lesions of the heart. These surgeries can be categorized into:

Open-Heart Surgery: 

• The chest cavity is made open and direct access to the heart is provided for repair.
• Featured for work on complex defects, e.g., TOF or valve replacement.

Closed-Heart Surgery:

• The chest is opened without directly accessing the heart.
• Used for conditions like coarctation of the aorta.

Minimally Invasive Surgery: 

• Utilizes smaller incisions and advanced tools for quicker recovery.

Hybrid Procedures:

• Combines surgical and catheter-based techniques.

Catheter-Based Interventions:

• Non-operative manipulations (e.g., balloon angioplasty and device closure of septal lesions).

Why are Pediatric Cardiac Surgeries Needed?

These surgeries are performed to:

• Correct Congenital Heart Defects: Repair structural abnormalities present at birth.
• Improve Heart Function: Ensure proper blood flow and oxygenation.
• Prevent Complications: Reduce the risk of cardiovascular failure, infection, and developmental abnormalities.
• Enhance Quality of Life: Allow children to lead healthy and active lives.
• Support Growth and Development: Address issues that hinder physical and cognitive development.

Common Pediatric Cardiac Surgeries

1. Atrial Septal Defect (ASD) Repair: Describes the closure of the ventricular septum between the apical chambers of the heart.
2. Ventricular Septal Defect (VSD) Repair: Repairs a hole between the heart’s lower chambers.
3. Tetralogy of Fallot (TOF) Repair: Eliminates a sequence of four errors with an effect on blood flow/oxygenation.
4. Coarctation of the Aorta Repair: Depolymerization of the thoracic aorta to normalize aortic diameter and restore axis flow of blood.
5. Valve Repair or Replacement: Treats malfunctioning heart valves.
6. Arterial Switch Operation: Corrects transposition of the great arteries (TGA).
7. Fontan Procedure: Offers a pathway for hypoxic blood to avoid heart flow in one-chamber TGA.
8. Blalock-Taussig Shunt: Temporary shunt for enhanced oxygenation in cyanotic heart failure.

Procedure Steps

1. Pre-Surgery Evaluation: 

• Echocardiogram: Assesses heart structure and function.
• Electrocardiogram (ECG): Measures electrical activity of the heart.
• CT/MRI Scans: Provides detailed imaging for surgical planning.
• Blood Tests: Evaluate overall health and readiness for surgery.

2. Anesthesia: 

• Sedation of the child is induced with anesthesia.

3. Surgical Process:

• Incision: A chest incision is made to access the heart.
• Repair: The defect is corrected using sutures, patches, or implants.
• Cardiopulmonary Bypass (if needed): A heart-lung machine temporarily takes over heart function.

4. Closure and Monitoring: 

• The chest is closed, and the child is admitted to the pediatric intensive care unit (PICU) for observation.

Benefits of Pediatric Cardiac Surgeries

1. Improved Heart Function: Restores normal blood flow and oxygen delivery.
2. Enhanced Quality of Life: Enables children to engage in regular activities.
3. Prevention of Complications: Reduces the risk of heart failure or developmental delays.
4. High Success Rates: Advanced techniques ensure excellent outcomes.
5. Comprehensive Treatment: Addresses associated defects or conditions.

Cost of Pediatric Cardiac Surgeries 

• United States: $20,000 – $50,000 
• United Kingdom: $15,000 – $40,000 
• Thailand: $6,000 – $15,000
• India: $3,000 – $10,000 

Best Hospitals in India for Pediatric Cardiac Surgery

In India, there is state-of-the-art infrastructure for the management of pediatric cardiology and surgery. Notable hospitals include:

Metro Hospital Faridabad: 

• Renowned for advanced pediatric cardiac care and surgical expertise.
• Equipped with state-of-the-art technology and a dedicated PICU.

Fortis Healthcare (Delhi): 

• Known for its multidisciplinary approach to complex cardiac cases.
• Offers comprehensive pre-and post-operative care.

Max Healthcare (Delhi): 

• Specializes in minimally invasive and hybrid pediatric cardiac surgeries.
• High success rates in treating congenital heart defects.

Risks and Complications

Although pediatric cardiac surgeries are relatively safe, the risks are:

• Infection: Rare with proper postoperative care.
• Bleeding: Managed with advanced surgical techniques.
• Arrhythmias: Irregular heartbeats post-surgery.
• Residual Defects: May require additional interventions.
• Developmental Delays: Temporary, often addressed with therapy.

Recovery

Immediate Recovery:

• Hospital Stay: 5-10 days for monitoring and recovery.
• First Week: Focus on pain management and stabilizing heart function.

Long-Term Recovery:

• 1-3 Months: Most children resume normal activities and growth.
• Follow-Up Care: Regular check-ups to monitor heart health and development.
• Rehabilitation: Physical therapy may be recommended to aid recovery.