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Congenital Cardiac Surgery

Great Surgical Care at Marina del Rey Hospital

Why Choose Marina del Rey Hospital for Congenital Heart Defect Surgery?

The well-trained and highly skilled surgeons at Marina del Rey hospital offer a wide range of surgical approaches for various types of congenital heart defects. We provide patients with an individualized treatment regimen depending on the particularities of their specific cardiac malformation. Preoperative and postoperative care is also provided in order to ensure an efficient and quick recovery while avoiding potential health complications.

When an infant is born with a congenital heart defect, surgery may be required to correct the functioning of the heart. The purpose of surgery is either to completely eliminate the occurring heart defect, or, when the particularities of the case do not allow it, to alleviate the symptoms associated with a defective functioning of the heart. Depending on the severity of and the impairment caused by the diagnosed heart defect, surgery may be urgent or elective. There are over 40 types of congenital heart defects which can be reversed or significantly improved by undergoing various surgical procedures. Some of these congenital heart defects include:

  • Ebstein’s anomaly
  • Aortic valve stenosis
  • Complete atrioventricular canal defect

Congenital heart defect surgery can be divided into two categories, depending on the treatment approach used. Thus, surgical interventions aimed at reversing congenital heart defects can be:

  • Minimally invasive: These procedures require only one or two small incisions (of 2-4 inches) between the ribs, through which an X-ray camera, as well as the appropriate surgical instruments, are inserted in order to perform the corrective procedure
  • Open heart: During these procedures a larger incision (of 7-10 inches) is made across the sternum to open the chest bone and gain access to the heart, which is then followed by a more complex surgical intervention

Surgical interventions can also be classified by their purpose, as the severity of heart defects varies greatly and therefore the corrective procedure needs to be chosen accordingly. Consequently, depending on the primary objective, congenital heart defect surgery may be:

  • Palliative: Surgery aimed at alleviating the distressing symptoms accompanying heart defects which cannot be completely or partially eliminated by standard surgery, without involving the correction of the anomaly per se
  • Reparative: Surgery performed with the purpose of correcting heart defects to a greater or lesser extent, depending on the complexity of each case

Finally, there are multiple types of congenital heart defect surgery, depending on the specific heart defect which needs to be corrected. The following procedures are some of the most commonly performed and effective surgical interventions for heart defects:

  • Cardiac catheterization
  • Arterial switch procedure
  • Norwood procedure
  • Balloon angioplasty
  • Patent ductus arteriosus ligation
  • Atrial septal defect repair
  • Truncus arteriosus repair
  • Tricuspid atresia repair

Minimally Invasive Surgery

Minimally invasive surgery entails one or two small incisions of 2-4 inches between the ribs, through which an X-ray camera and the required surgical instruments are inserted. A cardiopulmonary bypass machine is also involved in this type of procedure, as the functioning of the heart and lungs needs to be temporarily interrupted during surgery. This device takes over the organs’ functions during the intervention. Minimally invasive surgery generally yields a faster recovery than open-heart surgery, as well as reduced risks. Some of the heart defects which may be suitable for this type of surgery include:

  • Aortic valve stenosis
  • Aortic valve regurgitation
  • Coronary artery disease
  • Tricuspid valve disease
  • Mitral valve prolapse
  • Mitral valve stenosis
  • Atrioventricular septal defect

Open-heart Surgery

Open-heart surgery represents a more complex type of intervention which involves a larger incision of 7 to 10 inches across the middle of the sternum. The chest bone will be opened in order to allow access to the heart. Open-heart surgery is the most commonly performed for the correction of congenital heart defects, as only a few types of malformation are eligible for minimally invasive interventions. The functions of the heart and lungs will be taken over by a cardiopulmonary bypass machine in this case as well.

Occasionally, when heart defects concerning the aorta need to be reversed, hypothermic circulatory arrest may be induced to the patient. During this state, the temperature of the body will lower and the cellular activity will also be reduced. Consequently, the blood flow will be temporarily stopped so that the surgeon can operate under improved conditions. However, due to the risks associated with hypothermic circulatory arrest such as postoperative strokes and neurological deficits, a more efficient method known as axillary cannulation is preferred. It entails the insertion of a drainage tube (cannula) through an artery located in the armpit region.

Palliative Surgery

Palliative surgery can reduce discomfort and pain accompanying certain heart defects to a great extent and thus it may prove to be the most suitable approach when the malformation cannot be corrected via standard surgery. There are multiple types of palliative procedures, some of the most commonly used being:

  • The Fontan procedure may be appropriate for patients who have a single ventricle. It allows the flow of deoxygenated blood into the lungs, also avoiding the heart. Following this intervention, the ventricle will pump oxygenated blood.
  • During the Blalock-Taussig procedure, a tube will be inserted in the chest cavity in order to connect the aorta to the pulmonary artery. Blood flow to the lungs will thus be increased.
  • Another palliative method involves the placement of a band around the pulmonary artery (pulmonary artery band) so that blood flow to the lungs will be decreased.

Reparative Congenital Heart Surgery

Reparative congenital heart surgery is performed with the purpose of partially or completely correcting an existent heart defect. There are various instances in which reparative congenital heart surgery may be suggested. Some of those include:

  • Restoring the normal position of the great arteries and coronary arteries in order to correct transposition of the great arteries
  • Correcting the Tetralogy of Fallot, or the stretching or widening of the pulmonic valve
  • Eliminating coarctation by widening a narrow aorta
  • Repairing ventricular or atrial septal defects, as well as atrioventricular valves, by using artificial grafts, or grafts made of tissue collected from the patient

Cardiac Catheterization

Cardiac catheterization, also known as interventional catheterization when its used to correct congenital heart defects, is performed by inserting a thin hollow tube (catheter) directly into the heart and its adjacent blood vessels via a small incision in the patient’s arm, neck, or groin. Using X-rays or fluoroscopy, the surgeon can then repair the occurring heart defect. Depending on the complexity of each case and the duration of the procedure, general or local anesthesia is used to sedate the patient. Cardiac catheterization is suitable both for infants and adults.

Arterial Switch Procedures

When the position of the arteries that carry blood from the heart to the lungs is inverted, surgery is required to restore the proper functioning of the heart. This malformation typically requires urgent treatment, as defective blood flow deprives the body of oxygen and can thus be life-threatening. Arterial switch procedures are most often performed within the first few weeks of an infant’s life. During this open heart surgery, the pulmonary artery and the aorta will be assigned their normal positions in order to ensure correct blood flow. Foregoing surgery, prostaglandin, a drug which keeps the ductus arteriosus open for improved circulation, will be administered to the patient. However, the narrowing of large vessels may occur following surgical intervention, and additional procedures such as balloon dilation may be required.

Norwood Procedure

The Norwood procedure is generally performed on infants who only have one ventricle, or who have been diagnosed with other defects in this region of the heart. The primary goal of the Norwood procedure is the reconstruction of the aorta using the pulmonary artery to increase blood flow to the rest of the body. An additional palliative procedure (such as a Blalock-Taussig shunt) may also be performed to maintain normal blood flow to the lungs and subsequent regions.

Balloon Angioplasty

Balloon angioplasty, also known as balloon catheter dilation, is most frequently used when the heart defect in question involves the narrowing of any part of the heart’s circulatory system. A catheter with a deflated balloon attached to its tip is inserted into the affected region through a blood vessel in the leg or groin. When the device is placed into the narrow region of the heart, the balloon will slowly deflate in order to widen it and thus promote correct blood flow.

Patent Ductus Arteriosus Ligation

If the ductus arteriosus of an infant fails to close shortly after birth, a patent ductus arteriosus ligation may be necessary. Although this procedure may require surgery, less invasive methods may also be an option. During a patent ductus arteriosus ligation, a catheter is inserted through a blood vessel in the leg or groin. A small metal coil or a similar device is then passed through the catheter into the heart to obstruct the opening so that blood flow towards that region will be stopped.

Atrial Septal Defect Repair

An atrial septal defect refers to a hole in the atrial septum, or the wall between the two atria. In patients with atrial septal defects, oxygenated and deoxygenated blood will often mix, which can lead to various lifelong complications. Both minimally invasive and open heart surgeries are used to correct atrial septal defect, depending on the particularities of the case. In minimally invasive defect repair, a device with two umbrella-shaped clips will be passed through a catheter and attached to the sides of the atrial septum in order to close the opening. In open heart surgery, the hole will be repaired by using stitches or a patch.

Truncus Arteriosus Repair

In the majority of cases, truncus arteriosus repair implies open heart surgery. This heart defect is quite rare and occurs when the aorta, coronary arteries, and pulmonary artery are all contained within a common trunk, instead of two separate vessels. Due to the fact that each case is unique, the condition presents various degrees of complexity. Surgery is usually performed within the first days of an infant’s life, as complications can occur if it is left untreated. During the procedure, the pulmonary arteries are separated from the aortic trunk and any additional defects are corrected. Children diagnosed with truncus arteriosus who undergo corrective surgery often need a second intervention at one point during their lifetime.

Tricuspid Atresia Repair

Tricuspid atresia repair is required when the tricuspid valve is deformed, narrow, or nonexistent. The skin of infants born with this heart defect is typically blue, due to the fact that their blood is insufficiently oxygenated. A series of interventions are often needed to completely correct this condition. Tricuspid atresia repair can involve the correction or the full replacement of the valve.

The risks of surgery aimed at correcting congenital heart defects vary greatly depending on the severity and complexity of the condition, as well as on the type of intervention. Moreover, there are specific complications associated with each surgical treatment approach.

The risks associated with minimally invasive surgery include:

  • Wound infection
  • Bleeding
  • Arrhythmia (irregular heart rhythm)
  • Stroke

It is important to note that this type of surgery is considered to be one of the most effective treatment approaches for congenital heart defects that are not particularly complex, and presents a relatively low risk of subsequent heath complications.

The risks associated with open-heart surgery include:

  • Seizures, which are quite common and appear in approximately 20% of cases without causing any long-term damage
  • Arrhythmia
  • Stroke, which may produce short-term or permanent damage
  • Infection
  • Excess of carbon dioxide in the blood
  • Low blood pressure
  • Neurological dysfunction, which occurs in 25% in patients who undergo this type of surgery
  • Hemorrhage
  • Cardiac arrest
  • Congestive heart failure
  • Shock
  • Kidney damage

The large number of complications associated with open-heart surgery should not discourage one to opt for this type of intervention, as some congenital heart defects left untreated can lead to the development of severe or life-threatening conditions, and may even result in death.

The risks associated with cardiac catheterization are rare, but may include:

  • Hemorrhage
  • Bruising
  • Stroke
  • Arrhythmia
  • Infection
  • Forming of blood clots
  • Heart attack
  • Allergic reactions to the medication or dye used
  • Pseudoaneurysm (damage to the artery through which the catheter was introduced)

The risks associated with arterial switch procedures include:

  • Bleeding
  • Infection
  • Stroke
  • Narrowing of the pulmonary artery
  • Deforming of the coronary artery, which may result in decreased blood flow to the heart

The Norwood procedure entails particularly serious risks, with a mortality rate of approximately 20%. Due to the complexity of the intervention, the risks include:

  • Postoperative bleeding
  • Renal complications
  • Cardiovascular complications
  • Cardiac arrest
  • Persistent neurologic deficit
  • Respiratory insufficiency
  • Arrhythmia
  • Recurrent laryngeal nerve injury
  • Pericardial effusion
  • Pneumonia
  • Acidosis
  • Low cardiac output

The risks associated with balloon angioplasty include:

  • Restenosis (the narrowing of the artery occurring after the intervention)
  • Hemorrhage
  • Forming of blood clots
  • Coronary artery damage
  • Stroke
  • Heart attack
  • Arrhythmia
  • Renal complications

The complications associated with patent ductus arteriosus ligation are rare, but include:

  • Neurodevelopmental impairment
  • Chronic lung disease
  • Retinopathy of prematurity

The risks associated with atrial septal defect repair include:

  • Arrhythmia
  • Stroke
  • Right heart failure
  • Pulmonary hypertension

The risks associated with truncus arteriosus repair refer to heart-related complications such as:

  • Pulmonary hypertension
  • Respiratory conditions
  • Arrhythmia
  • Cardiomegaly (the enlargement of the heart)
  • Regurgitation (leaky heart valves)
  • Heart failure

The risks associated with tricuspid atresia corrective surgery include:

  • Stroke or other nervous system complications
  • Ascites (the accumulation of fluid in the abdomen)
  • Pleural effusion (the accumulation of fluid in the lungs)
  • Heart failure
  • Chronic diarrhea
  • Blockage of the inserted shunt

Similar to the risks and complications, the benefits of congenital heart defect surgery can very depending on the type of malformation and the particularities of each case. Patients who undergo open-heart surgery may experience the permanent or partial correction of their congenital heart defect. Patients who undergo palliative interventions may benefit from a significant alleviation of their distressing symptoms. Patients who are treated with minimally invasive surgical approaches may experience an additional series of benefits, such as reduced hemorrhage, faster recovery time, less visible scarring, and a lower risk of infection.

Frequently Asked Questions About Congenital Cardiac Surgery

These type of heart defects are called congenital because they are present since the moment of birth.

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After any type of surgery, it’s important to follow-up with your doctor in order to understand what result the surgery had and reduce the risk of complications.

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During your discharge, you will be taught how to take proper care of your surgical wound.

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Once you return home, watch out for any signs that might indicate complications.

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Yes, activity restrictions will be needed after a congenital cardiac surgery and your surgeon will instruct you regarding the activities that are appropriate for the nature of your defect and the surgery you have undergone.

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