Heart Surgery for Congenital Defects Health Article

Definition

Heart surgery for congenitaal defects consists of a variety of surgical procedures that are performed to repair the many types of heart defects that may be present at birth and can go undiagnosed into adulthood.

Purpose

Heart surgery for congenital defects is performed to repair a defect, providing improved blood flow to the pulmonary and systemic circulations and better oxygen delivery to the body. Congenital heart defects that are symptomatic at birth must be treated with palliative or complete surgical repair. Defects that are not symptomatic at birth may be discovered later in life, and will be treated to relieve symptoms by palliative or complete surgical repair. Surgery is recommended for congenital heart defects that result in a lack of oxygen, a poor quality of life, or when a patient fails to thrive. Even lesions that are asymptomatic may be treated surgically to avoid additional complications later in life.

Demographics

Congenital heart disease is estimated to involve less than 1% of all live births. As some defects are not found until later in life, or may never be diagnosed, this number may actually be higher. Many congenital defects are often incompatible with life leading to miscarriage and stillbirths. During a child's first year of life, the most common defects that are symptomatic include ventricular septal defect (VSD), transposition of the great vessels (TGV), tetralogy of Fallot, coarctation of the aorta, and hypoplastic left heart syndrome. Premature infants have an increased presentation of VSD and patent ductus arteriosus. Diabetic mothers have infants with a higher incidence of congenital heart defects than non-diabetic mothers. Abnormal chromosomes increase the incidence of congenital heart defects. Specific to trisomy 21 (Down syndrome), 23–56% of infants have a congenital heart defect.

Description

Congenital heart defects can be named by a number of specific lesions, but may have additional lesions. Classification best describes lesions by the amount of pulmonary blood flow (increased or decreased pulmonary blood flow) or the presence of an obstruction to blood flow. The dynamic circulation of the newborn as well as the size of the defect will determine the symptoms. 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 is symptomatic, at age four otherwise
• tetralogy of Fallot: age varies, depending on the patient's 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 and restore normal pulmonary and systemic circulation. Sometimes, multiple, serial surgical procedures are necessary.

Many congenital defects are often associated so that the surgical procedures described may be combined for complete repair of a specific congenital defect.

Repair for simple cardiac lesions can be performed in the cardiac catheterization lab. 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.