Pediatric Cardiothoracic Surgery

Congenital heart defects can be both simple defects with no symptoms at all or complex defects with severe, fatal symptoms. Most of these defects can be treated. It is only in case of by birth defects that patients need special care and treatment. However, this number is very small.

The diagnosis and treatment of these heart defects has noticed a great improvement in past few years. The advent of technologies has made things easier and more positive for patients. Due to this most children who have heart defects by birth, can be treated before they reach adulthood. In almost all cases, they live a happy and healthy life afterwards.

Most of the patients of heart defects require special care throughout their life. These patients have to take care of their health insurance, employment, pregnancy and contraception, and other health issues.

In the patients with congenital heart defects, the normal flow of blood changes through the heart because some parts of the heart remain undeveloped at the time of birth.

Holes in the Heart (Septal Defects)

The two chambers of heart are separated by the septum which is a wall like structure. This ensures that blood from both sides does not mix. In some cases an infant is born with a hole in the septum which allows the blood of both chambers to mix.

1. Atrial septal defect (ASD): When an infant is born with a hole in the part that separates the atria-the upper chambers of the heart, it is known as ASD. Because of this defect the oxygen-rich blood from the left atrium does not flow to the left ventricle rather it flows into the right atrium. ASD patients do not show very strong signs and in many cases they are negligible. When the ASD is tiny, very small amount of blood leaks from one atrium to the other. These kind of ASDs do not affect the function of heart and hence they do not require any treatment at all. In a number of cases the ASD closes on its own as the heart grows with the growth of an individual.

On the other hand considerable amount of blood may leak from one atrium to the other in case the ASD is medium to large. Such ASDs do not fill or close on their own.

In 50% cases the ASDs either fill on their own or the size is so small that no treatment is required. On the other hand medium to large ASDs are repaired using a catheter procedure or open-heart surgery.

1. Ventricular septal defect (VSD): A VSD is a hole that occurs in the part of the septum that separates the ventricles-the lower chambers of the heart. Because of this hole the oxygen-rich blood flows from the left ventricle into the right ventricle. As opposed to this the blood should flow into the aorta and out to the body. VSD can be both small and large and in most cases the smaller VSD closes on its own without causing any damage to the patient. In case of large VSD, the left side of the heart has to work harder because of the extra flood flow which in turn increases blood pressure in the right side of the heart and lungs. The large and medium VSDs can be repaired by using open-heart surgery.

Simple congenital heart defects may also affect the heart's valves. The function of these valves is to control the flow of blood from the atria to the ventricles and from the ventricles into the two large arteries connected to the heart. There can be following defects in valves:

1. Stenosis:- When flaps of a valve thicken, stiffen, or fuse together, it causes Stenosis. Because of this the valve does not open fully and the heart is forced to work harder to pump blood through the valve.
2. Atresia:- When a valve does not form correctly and there is an absence of hole for blood to pass through , this type of defect occurs. Atresia of a valve generally results in more complex congenital heart disease.
3. Regurgitation:- This occurs when the valve fails to close completely and blood leaks back through the valve.

In case of complex congenital heart defects a surgery has to be performed to correct them. Modern technologies have now made it possible for doctors to treat and repair even the most complex defects with high success rate.

Tetralogy of Fallot is one of the most common complex heart defects. It is a combination of four defects:

• Pulmonary valve stenosis.
• A large VSD.
• An overriding aorta: The aorta naturally sits just over the left ventricle but in this type of defect, it goes sits above both the left and right ventricles over the VSD. This allows oxygen-poor bloodcan flow directly into the aorta from the right ventricle. This blood has to otherwise flow from the pulmonary artery to the lungs.
• Right ventricular hypertrophy: This type of heart defect occurs when the muscle of the right ventricle has to work harder and it gets thicker.

These four defects indicate that enough blood is not reaching the lungs to get oxygen, and oxygen-poor blood flows out to the body.

• Children and infants with tetralogy of Fallot experience episodes of cyanosis which can get serious sometimes. Open heart surgery is performed either right after birth or later during childhood to repair Tetralogy of Fallot. The time decided for the surgery depends on how much the pulmonary artery is narrowed.
• Pulmonary valve stenosis.

Some of the heart defects show sign and symptoms which depend on the number, type, and severity of the defects. When the defect is severe signs and symptoms can be observed in infants. These signs and symptoms include:

• Rapid breathing
• Poor blood circulation
• Congenital heart defects don't cause chest pain or other painful symptoms. Heart defects can cause abnormal blood flow through the heart that will make a certain sound called a heart murmur.
• Shortness of breath
• Cyanosis (a bluish tint to the skin, lips, and fingernails)
• Fatigue (tiredness)
• Fatigue with physical activity
• A buildup of blood and fluid in the lungs
• A buildup of fluid in the feet, ankles, and legs

The severe congenital heart defects usually show up during pregnancy or soon after birth. Less severe defects take time to show up and they may not be diagnosed until later childhood.

More often than not, minor defects show almost no signs and symptoms. They are usually diagnosed on the basis of other physical exam and tests done for another reason.

Doctors specialized in care and diagnosis of infants with heart problems is called pediatric cardiologists.Cardiac surgeons on the other hand specialize in treating heart defects. These surgeon perform surgeries to repair heart defects.

Physical Exam:-

During a physical exam, the doctor will:

• Observe your child's heart and lungs with a stethoscope
• Look for signs of a heart defect, such as cyanosis (a bluish tint to the skin, lips, or fingernails), rapid breathing, delayed growth, shortness of breath, or signs of heart failure

Diagnostic Tests

• Echocardiography
• Pulse Oximetry
• Cardiac Catheterization
• EKG (Electrocardiogram)
• Chest x ray

The growth and development of some infants and teenagers with congenital heart defects gets slowed down. A kid may get easily tired if he or she has to pump harder than normal because of a heart defect. These kids can't even eat properly as they may feel tired while chewing their food. This in turn leads to thinner body frame and weakness. In some cases kids are slower in initiating physical movements such as rolling over, sitting, and walking. Proper treatment and surgery promotes growth and development of the child.

Physical activity is good for overall health and growth of children as it strengthens muscles and keeps them healthy. It is important to take doctor's advice on how much and what kind of activity will be good for the kid. In some cases when kids have congenital heart defects they may have to check their physical activity and limit it.