Heart Surgery for Congenital Defects Health Article

Definition

A variety of surgical procedures that are performed to repair the many types of heart defects that may be present at birth.

Purpose

Heart surgery for congenital defects is performed to repair a defect as much as possible and improve the flow of blood and oxygen to the body. While congenital heart defects vary in their severity, most require surgery. Surgery is recommended for congenital heart defects that result in a lack of oxygen, a poor quality of life, or a patient who does not thrive. Some types of congenital heart defects that don't cause symptoms are treated surgically because they can lead to serious complications.

Precautions

There are many types of surgery for congenital heart defects and many considerations in the decision to operate. The patient's cardiologist or surgeon will discuss these issues on an individual basis.

Description

There are many types of congenital heart defects. Most obstruct the flow of blood in the heart, or the vessels near it, or cause an abnormal flow of blood through the heart. Rarer types include newborns born with one ventricle, one side of the heart that is not completely formed, or the pulmonary artery and the aorta coming out of the same ventricle. Most congenital heart defects require surgery during infancy or childhood. Recommended ages for surgery for the most common congenital heart defects are:

• atrial septal defects: during the preschool years
• patent ductus arteriosus: between ages one and two
• coarctation of the aorta: in infancy, if it's symptomatic, at age four otherwise
• tetralogy of Fallot: age varies, depending on the patient's signs and symptoms
• transposition of the great arteries: often in the first weeks after birth, but before the patient is 12 months old

Surgical procedures seek to repair the defect as much as possible and restore circulation to as close to normal as possible. Sometimes, multiple, serial, surgical procedures are necessary. Smaller congenital heart defects can now be repaired in a cardiac catheterization lab instead of an operating room. Catheterization procedures include balloon atrial septostomy and balloon valvuloplasty. Surgical procedures include arterial switch, Damus-Kaye-Stansel procedure, Fontan procedure, Ross procedure, shunt procedure, and venous switch or intra-atrial baffle.

Catheterization procedures

Balloon atrial septostomy and balloon valvuloplasty are cardiac catheterization procedures. Cardiac catheterization procedures can save the lives of critically ill neonates and in some cases eliminate or delay more invasive surgical procedures. It is expected that catheterization procedures will continue to replace more types of surgery for congenital heart defects in the future. A thin tube called a catheter is inserted into an artery or vein in the leg, groin, or arm and threaded into the area of the heart which needs repair. The patient receives a local anesthetic at the insertion site and is awake but sedated during the procedure.

BALLOON ATRIAL SEPTOSTOMY. Balloon atrial septostomy is the standard procedure for correcting transposition of the great arteries; it is sometimes used in patients with mitral, pulmonary, or tricupsid atresia (atresia is a defect that causes the blood to carry too little oxygen to the body). Balloon atrial septostomy enlarges the atrial opening. A special balloon-tipped catheter is inserted into the right atrium and inflated to create a large opening in the atrial septum.

BALLOON VALVULOPLASTY. Balloon valvuloplasty uses a balloon-tipped catheter to open a narrowed heart valve, improving the flow of blood. It is the procedure of choice in pulmonary stenosis and is sometimes used in aortic stenosis. Balloons made of plastic polymers are placed at the end of the catheter and inflated to relieve the obstruction in the heart valve. Long-terms results are excellent in most cases. The operative death rate is 2–4%.