Congenital heart defect
corrective surgery fixes or treats a heart defect that a child is
born with. A baby born with one or more heart defects has congenital
heart disease. Surgery is needed if the defect is dangerous to the child’s
health or well-being.
Patent ductus arteriosus (PDA) ligation:
- Before
birth, the baby has a blood vessel that runs between the aorta (the main
artery to the body) and the pulmonary artery (the main artery to the
lungs), called the ductus arteriosus. This opening usually closes shortly
after birth. A PDA occurs when this opening does not close after birth.
- In
most cases, the doctor will use medicine to close off the opening. If this
does not work, then other techniques are used to close the opening.
- Sometimes
the PDA can be closed with a procedure that does not involve surgery. The
procedure is usually done in a laboratory that uses x-rays. In this procedure,
the surgeon inserts a wire into an artery in the leg and passes it up
to the heart. There are no cuts, except for a tiny hole in the groin.
Then, a small metal coil or another device is passed through the wire into
the infant's arteriosus artery. The coil or other device blocks the blood
flow, and this corrects the problem.
- Another
method is to make a small surgical cut on the left side of the chest. The
surgeon finds the PDA and then ties off or clips the ductus
arteriosus, or divides and cuts it. Tying off the ductus arteriosus is
called ligation. This procedure may be done in the neonatal intensive care
unit (NICU).
Coarctation of the aorta repair:
- Coarctation
of the aorta occurs when a part of the aorta has a very narrow section,
like in an hourglass timer.
- To
repair this defect, a cut is usually made on the left side of the chest,
between the ribs. There are many ways to repair coarctation of the aorta.
- The
most common way to repair it is to cut the narrow section and make it
bigger with a patch made of Gore-tex, a man-made (synthetic) material.
- Another
way to repair this problem is to remove the narrow section of the aorta
and stitch the remaining ends together. This can usually be done in older
children.
- A
third way to repair this problem is called a subclavian flap. First, a cut
is made in the narrow part of the aorta. Then, a patch is taken from the
left subclavian artery (the artery to the arm) to enlarge the narrow
section of the aorta.
- A
fourth way to repair the problem is to connect a tube to the normal
sections of the aorta, on either side of the narrow section. Blood flows
through the tube and bypasses the narrow section.
- A
newer method does not require surgery. A small wire is placed through an
artery in the groin and up to the aorta. A small balloon is then opened up
in the narrow area. A stent or small tube is left there to help keep the
artery open. The procedure is done in a laboratory with x-rays. This
procedure is often used when the coarctation occurs after it has
already been fixed.
Atrial septal defect (ASD) repair:
- The
atrial septum is the wall between the left and right atria (upper
chambers) of the heart. A hole in that wall is called an ASD.
- Sometimes,
an ASD can be closed without open-heart surgery. First, the surgeon makes
a tiny cut in the groin. Then the surgeon inserts a wire into a
blood vessel that goes to the heart. Next, two small umbrella-shaped
"clamshell" devices are placed on the right and left sides of
the septum. These two devices are attached to each other. This closes the
hole in the heart. Not all medical centers do this procedure.
- Open-heart
surgery may also be done to repair ASD. Using open-heart surgery, the
septum can be closed using stitches. Another way to cover the hole is with
a patch.
Ventricular septal defect (VSD) repair:
- The
ventricular septum is the wall between the left and right ventricles
(lower chambers) of the heart. A hole in the ventricular septum is called
a VSD.
- By
age 1, most small VSDs close on their own. However, those VSDs that do
stay open after this age must be closed.
- Larger
VSDs, small ones in certain parts of the ventricular septum, or ones that
cause heart failure or endocarditis (inflammation) need open-heart
surgery. The hole in the septum is usually closed with a patch.
- Some
septal defects can be closed without surgery. The procedure involves
passing a small wire into the heart and placing a patch over the
defect.
Transposition of the great vessels repair:
- In a
normal heart, the aorta comes from the left side of the heart, and the
pulmonary artery comes from the right side. In transposition of the great
vessels, these arteries come from the opposite sides of the heart. The
child may also have other birth defects.
- Correcting
transposition of the great vessels requires open-heart surgery. If possible,
this surgery is done shortly after birth.
- The
most common repair is called an arterial switch. The aorta and pulmonary
artery are divided. The pulmonary artery is connected to the right
ventricle, where it belongs. Then, the aorta and coronary arteries are
connected to the left ventricle, where they belong.
Truncus arteriosus repair:
- Truncus
arteriosus is a rare condition that occurs when the aorta, coronary
arteries, and pulmonary artery all come out of one common trunk. The
disorder may be very simple, or very complex. In all cases, it
requires open-heart surgery to repair the defect.
- Repair
is usually done in the first few days or weeks of the infant's life. The
pulmonary arteries are separated from the aortic trunk, and any defects
are patched. Usually, children also have a ventricular septal defect, and
that is also closed. A connection is then placed between the right
ventricle and the pulmonary arteries.
- Most
children need one or two more surgeries as they grow.
Tricuspid atresia repair:
- The
tricuspid valve is found between the upper and lower chambers on the right
side of the heart. Tricuspid atresia occurs when this valve is deformed,
narrow, or missing.
- Babies
born with tricuspid atresia are blue because they cannot get blood to the
lungs to pick up oxygen.
- To
get to the lungs, blood must cross an atrial septal defect (ASD),
ventricular septal defect (VSD), or a patent ductus artery (PDA). (These
conditions are described above.) This condition severely restricts blood
flow to the lungs.
- Soon
after birth, the baby may be given a medicine called prostaglandin E. This
medicine will help keep the patent ductus arteriosus open so
that blood can continue to flow to the lungs. However, this will only work
for a while. The child will eventually need surgery.
- The
child may need a series of shunts and surgeries to correct this
defect. The goal of this surgery is to allow blood from the body to flow
into the lungs. The surgeon may have to repair the tricuspid valve,
replace the valve, or put in a shunt so that blood can get to the lungs.
Total anomalous pulmonary venous return (TAPVR)
correction:
- TAPVR
occurs when the pulmonary veins bring oxygen-rich blood from the lungs
back to the right side of the heart, instead of the left side of the
heart, where it usually goes in healthy people.
- This
condition must be corrected with surgery. When the surgery is
done depends on how sick the baby is. The surgery may be done in the
newborn period if the infant has severe symptoms. If it is not done right
after birth, it is done in the first 6 months of the baby's life.
- TAPVR repair requires open-heart surgery. The pulmonary veins are routed back to the left side of the heart, where they belong, and any abnormal connections are closed.
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