A
successful cardiac surgery in children requires an expert
medical team - doctors, nurses, and other support staff - who are experienced
in such surgeries, can promptly recognize problems and emerging side effects,
and know how to react swiftly and properly if problems do arise. A cardiac
surgery program will also recognize the importance of providing patients and
their families with emotional and psychological support before, during and
after the surgery, and will make personal and other support systems readily
available to families for this purpose. We make this difficult journey easy for
the patient and his relatives.
Paediatric surgeries deal with the
correction of abnormalities present in the heart of new-borns, infants or
children. Most of the defects are present since birth (congenital). They all
come under the category of congenital heart defects. Some are present since
birth but cause symptoms after a few years and some cause symptoms immediately
after birth.
Major Types of Cardiac Defects
in Children :
Any defect in the septum or valves or position of
arteries causes mixing of pure and impure blood or reduced blood supply to the
body. If the defect is severe it is incompatible with life and requires
immediate surgical intervention. Circulation of impure blood in the body
results in bluish discoloration of the body called cyanosis. The tissues do not
receive adequate amount of oxygen and hence cannot function.
The major cardiac defects include
- Atrial Septal Defect
- Ventricular Septal Defect,
- Fallot’s Tetralogy
- Valvular
defects
Approximately
25000-30000 children per year are affected by these defects. The paediatric surgeries deal with correction of these malformations.
1
ASD- Atrial Septal Defect
refers to a hole in the septum that separates the right and left atrium. This
results in mixing of pure and impure blood.
Depending on the
size of the defect, the symptoms may range from no symptoms to bluish
discoloration of the body, increase pulmonary blood pressure and irregular
cardiac contractions (arrhythmias).
It is corrected
by open heart surgery. The sternum is split in the midline. Arterial and double
venous (superior vena cava and inferior vena cava) vessels are clamped. By
applying cardiopulmonary bypass (heart lung machine), the aorta is clamped, and
the heart is temporarily paralyzed by a solution. The right atrium is opened
and the defect is sutured.
At our world
class hospitals in India, minimally invasive approaches to the repair of ASD have
now been developed. In most cases, the
size of the incision is simply decreased with different approaches to
cardiopulmonary bypass. Examples include partial or full submammary skin
incision, hemisternotomy, and limited thoracotomy. The goal is to improve
cosmetic results because these approaches are not associated with decreased
morbidity or mortality.
In recent times,
ASD have been closed by using a variety of catheter-implanted occlusion devices
rather than by direct surgical closure with cardiopulmonary bypass. These
devices are placed through a femoral venous approach and are deployed like an
umbrella to seal the septal defect. These devices work best for centrally
located secundum defects.
Our cardiologist
with congenital experience will continue patient care to monitor for recurrence
of the shunt and to ensure that the patient has returned to normal activities
and cardiac function.
Ventricular Septal Defect - is a hole in the wall between the right and
left ventricles of the heart. This abnormality
usually develops before birth and is found most often in infants. A ventricular
septal defect can allow newly oxygenated blood to flow from the left ventricle,
where the pressures are higher, to the right ventricle, where the pressures are
lower, and mix with un-oxygenated blood. The mixed blood in the right ventricle
flows back or recirculates into the lungs. This means that the right and left
ventricles are working harder, pumping a greater volume of blood than they
normally would. Eventually, the left ventricle can work so hard that it starts to fail.
It can no longer pump blood as well as it did. Blood returning to the heart
from the blood vessels backs up into the lungs, causing pulmonary congestion,
and further backup into the body, causing weight gain and fluid retention. If
the VSD is large and surgically uncorrected, pressure can build excessively in
the lungs, resulting in pulmonary hypertension. The higher the pulmonary
pressure, greater the chances of blood flowing from the right ventricle to the
left ventricle, backwards, causing un-oxygenated blood to be pumped to the body
resulting in cyanosis (blue skin). The risk for these problems depends on the
size of the hole in the septum and how well the infant’s lungs function.
Small
VSDs’ are symptomless and closed spontaneously as the child grows. The large
VSDs’ cause symptoms like difficulty in breathing and feeding, poor growth and
pallor. The symptoms occur due to the increase in size of the right ventricle
(right ventricular hypertrophy) and increase in pressure inside the lungs
(pulmonary hypertension).
Two types
of surgeries are available -
a) Intra-Cardiac
Technique – the patient is attached to an external heart-lung
machine (which performs circulatory and respiratory function during surgery).
It is an open heart surgery in which the patient is placed under general
anaesthesia. The rib cage is cut open in the midline. The heart is directly
accessed and the defect is sutured.
b)
Trans- Catheter Technique – Surgical
instruments are passed through the catheter which is inserted in the femoral
artery at the groin. The catheter is slowly guided up towards the point of
defect to close it. It is a successful surgery.
With the separation of ventricles normal
circulation resumes. The enlarged heart comes back to normal size. Pulmonary
artery pressure reduces. The child’s growth fastens. The prognosis is
excellent.
FALLOT’S TETRALOGY: it is the most common congenital heart
defect in children. The defect results in mixing of pure and impure blood.
It comprises a combination of four defects-
right ventricular hypertrophy (increase in the size of right lower chamber),
ventricular septal defect (whole in the wall between the two ventricles),
abnormal position of aorta (aorta is on right side of heart instead of the
left) and pulmonary stenosis (narrowing of pulmonary valve opening which
prevents outflow of blood from right ventricle).
Two major surgeries help to correct these
abnormalities.
Blalock- Taussig’s operation is a palliative procedure performed in smaller infants
to increase blood flow to lungs and to allow the child to grow big enough to
withstand the corrective surgery. A connection is made between right subclavian
artery and pulmonary artery to pass more oxygenated blood to the latter. This
relieves the cyanosis to a great extent.
The total corrective surgery is performed in children
within 2 years of age. VSD is closed with a patch and the narrowed pulmonary
valve is opened. The outcome of surgery is favourable and most children lead a
healthy life after the surgery with minimum restrictions.
Double valve repair and replacement- valves are openings between two chambers and
also between a chamber and artery which allows unidirectional flow of blood.
The patency of these valves is very important for normal flow of blood. The
function of mitral valve (between left atrium and left ventricle) and the
aortic valve (between left ventricle and aorta) is very important. If these
valves get narrowed, the amount of blood passing from left atrium to left
ventricle (mitral valve) or from left ventricle to aorta (aortic valve) is
drastically reduced. In this case the heart will pump blood harder to push it
through the narrowed valves. But the blood will tend to go upwards back into
the pulmonary vein and finally to the lungs. This will cause excess blood in the
lungs leading to congestion. At the same time very less blood will come out
into the aorta from the left ventricle which will result in reduced blood and
oxygen supply to all the body parts.
5.
Double valve repair and replacement procedure aims at
correcting or replacing these both these damaged valves (aortic & mitral
together) with new functional valves.
This is done through the open heart surgery. The patient is put under
general anaesthesia and connected to the heart lung machine. This machine takes
over the pumping, circulatory, and respiratory functions of the heart and lung
till the surgical procedure is going on. The valves are accessed by cutting
open the rib cage and accessing the heart directly. The old valves are sliced
from their attachments and new valves are put in their place. The new valves
may be obtained from a cadaveric donor, or an animal (pig) or it may be made of
a nonreactive inert material. The patient needs to be given anticoagulants or
immunosuppressive to clotting of blood or rejection of organ. The prognosis of
this surgery is good. It is many a time a life-saving and life extending
surgery.
Estimated Costs for Heart Surgery/ Treatment at World Class Hospital in India
Open Heart Surgery + Angiography –
7000 US Dollars
Open Heart Surgery + Angiography +
Conduit - 13500 US Dollars
Closed Heart Surgery + Angiography +
Shunt – 7800 US Dollars
Valvuloplasty - 2300 US Dollars
PDA Device Closure – 6900 US Dollars
ASD Device Closure – 6900 US Dollars
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Heart Surgery in India with the Best Heart surgeons in India is what medical tourists coming to India look for and is delivered at best cardiac hospitals in India . No other destination in the world can match the unparalleled clinical excellence, technology infrastructure and cost advantage offered by MedWorld India affiliated heart hospitals in India to deliver 99 percent and above successful outcomes for heart surgery.
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