A person who has a heart defect that has been present since birth is diagnosed with congenital heart disease. Congenital heart disease includes problems with heart valves, structural defects of the heart muscle walls, and incorrect connections between the heart and the blood vessels that carry blood to and from the heart.
Many of the 36,000 children born with congenital heart disease each year have their heart defect surgically repaired while they are still young. However, congenital heart disease surgery is not a complete cure, and many children require medical observation and monitoring.
Adults may require congenital heart disease surgery when symptoms or complications caused by a heart defect that was not discovered or did not affect heart function in childhood have worsened over time. Other patients may need to have follow-up operations to treat congenital heart defects that were repaired in childhood.
Congenital heart disease surgery corrects heart defects that have been present from birth, including:
Atrial or ventricular septal defects; and
Coarctation of the aorta.
WHEN IS THE PROCEDURE INDICATED?
Surgery is indicated for congenital defects that begin to cause symptoms, or when treatment with medication is no longer effective. People may need follow-up surgery for a congenital heart defect that was treated during childhood.
The physician will perform a preoperative work-up to identify any health risks posed by the surgery, including:
Chest x ray;
Blood tests; and
People scheduled for surgery cannot take any drugs containing aspirin for 2 weeks before the surgery. Physicians will instruct patients who take anticoagulants (blood thinners) when to stop taking those drugs.
WHO IS ELIGIBLE?
People whose congenital heart defects cause symptoms that cannot be treated successfully with medications are eligible for surgical repair.
RISK FACTORS FOR POSSIBLE COMPLICATIONS
Surgical risk increases in patients who:
Have had recent or chronic illness, such as high blood pressure (hypertension), thyroid disease, or severe heart attack (myocardial infarction); and
Have chronic obstructive pulmonary disease, such as emphysema.
WHAT TO EXPECT
The patient is given general anesthesia and fluids through an intravenous (IV) tube.
To begin surgery, the surgeon makes an incision through the breastbone to open the chest and ribcage and access the heart. The heart is stilled and the patient is connected to a machine that stops blood from circulating through the coronary arteries while the surgeon works on the heart.
Atrial and ventricular septal defects: Small holes can be stitched closed using a synthetic thread. Surgeons will make a patch, or graft, to close a larger hole. Alternatively, surgeons repair the defects with minimally invasive procedures. The surgeon guides a catheter (a long, thin, flexible tube) through arteries to the heart. A metal-mesh device, called an occluder, attached to a synthetic fabric is passed through the catheter and expanded at the defect site where it is released, expanding to fill the gap in the septum.
Coarctation of the aorta surgery: The surgeon removes the narrowed segment of the aorta. Surgeons also dilate (widen) the narrowed section with an inflatable balloon catheter.
These procedures usually last between 2 and 5 hours.
POST-PROCEDURE GUIDELINES AND CARE
The patient typically spends the first day following the operation in an intensive care unit before moving to the cardiac care unit until discharge. The length of hospital stay varies.
The incision usually heals completely within 4 to 6 weeks. Pain, soreness, itching, bruising, and redness from this incision are common.
Some congenital heart defects increase the patient's risk for developing an infection of the endocardium, the membrane inside the heart's chambers and valves. Patients may need to take antibiotics before undergoing surgical and dental procedures.
Complications of congenital heart defect surgery include:
Kidney failure; and
Patients should contact their physician if they experience one or more of the following symptoms:
An increase in pain, swelling, redness, drainage, odor, or bleeding from the chest incision;
Fever, headache, muscle aches, or dizziness; or
New symptoms, such as shortness of breath, a cough, heartbeat irregularities, leg pain, or constipation.