Paediatric cardiac surgery is a highly specialised field dedicated to diagnosing and treating congenital and acquired heart conditions in infants, children, and adolescents. With medical advancements, this field has seen significant progress in surgical techniques, postoperative care, and survival rates.

Paediatric cardiac surgery in Malaysia is renowned worldwide due to the availability of experienced paediatric cardiothoracic surgeons who offer state-of-the-art treatments and innovative approaches to managing complex heart conditions.

In this comprehensive guide for parents and caregivers, we take a look at the various types of paediatric heart surgery, the recovery process after surgery and more.

Common Conditions Requiring Paediatric Cardiac Surgery

Some heart conditions necessitate early surgical intervention, including:

• Congenital Heart Defects (CHDs): Structural issues present at birth, affecting the heart’s function.
• Atrial Septal Defect (ASD): A hole in the atrial septum, allowing oxygen-rich and oxygen-poor blood to mix.
• Ventricular Septal Defect (VSD): A hole in the ventricular septum, leading to increased workload on the heart.
• Tetralogy of Fallot (TOF): A combination of four heart defects that lead to oxygen-poor blood circulation.
• Patent Ductus Arteriosus (PDA): Failure of a foetal blood vessel to close after birth, leading to abnormal blood flow.
• Coarctation of the Aorta (CoA): Narrowing of the aorta, affecting blood circulation.
• Hypoplastic Left Heart Syndrome (HLHS): Underdevelopment of the left side of the heart, requiring staged surgeries.
• Transposition of the Great Arteries (TGA): A condition where the two main arteries are switched in position.

Early diagnosis and timely intervention by an expert paediatric cardiothoracic surgeon can greatly improve outcomes and quality of life for affected children.

Types of Paediatric Heart Surgery

Different surgical techniques are used depending on the severity of the heart condition

1. Open-heart Surgery

Involves opening the chest and using a heart-lung bypass machine to maintain circulation while the heart is being repaired. Common open-heart procedures include:

• ASD and VSD Repairs – Closing septal defects with patches.
• Tetralogy of Fallot Repair – Correcting the four defects in a single surgery.
• Arterial Switch Operation – Used for TGA to restore normal blood flow.

2. Closed-heart Surgery

This procedure does not require stopping the heart or using a heart-lung machine. Examples include:

• Patent Ductus Arteriosus (PDA) Ligation – Closing the open blood vessel.
• Coarctation of the Aorta Repair – Widening the narrowed aorta without stopping the heart.

3. Minimally Invasive Cardiac Surgery (MICS)

Involves small incisions and specialised instruments to correct defects, leading to quicker recovery and minimal scarring. Some procedures include:

• Robot-Assisted Surgery – Enhancing precision and reducing trauma.
• Catheter-Based Interventions – Non-surgical techniques like balloon angioplasty and device closure of septal defects.

4. Heart Transplantation

In severe cases where the heart is irreparably damaged, a heart transplant may be the only option. It involves replacing the diseased heart with a healthy donor heart. A skilled paediatric cardiothoracic surgeon ensures these procedures are conducted with high precision and care, improving survival rates and post-surgery outcomes.

Risks Associated with Paediatric Cardiac Surgery

Any paediatric cardiac surgery is a complex and delicate procedure. While it can be life-saving, it also carries several risks. Hence any discussion about these procedures is incomplete without weighing in the risks.

Surgical Risks

• Bleeding: Excessive bleeding during or after surgery may require blood transfusions.
• Infection: Postoperative infections, including wound infections, pneumonia, or bloodstream infections can occur post-surgery.
• Blood Clots: There is a risk of clot formation, which may lead to stroke or other complications.

Cardiac-Related Risks

• Arrhythmias: Irregular heartbeats may occur after surgery and might require medication or a pacemaker.
• Heart Failure: The heart may struggle to pump efficiently after the procedure.
• Residual Defects: Some congenital defects may not be fully corrected, requiring additional procedures.

Neurological Risks

• Brain Injury or Stroke: Reduced blood flow to the brain during surgery can lead to neurological complications.
• Developmental Delays: Some children may experience cognitive or motor skill delays, especially after prolonged surgery.

Respiratory Risks

• Lung Complications: Children may develop respiratory distress or pneumonia post-surgery.
• Prolonged Ventilator Support: Some children may need mechanical ventilation for an extended period.

Kidney and Liver Complications

• Kidney Dysfunction: Reduced blood flow during surgery can lead to temporary or permanent kidney issues.
• Liver Dysfunction: Certain heart surgeries can affect liver function, particularly in children with pre-existing conditions.

Long-Term Risks

• Growth and Development Issues: Some children may experience slower growth due to heart-related complications.
• Need for Future Surgeries: Some congenital heart defects require multiple surgeries or lifelong medical care.
• Psychological and Emotional Impact: Hospital stays and medical procedures can cause anxiety and emotional distress in both the child and their family.

How to Reduce These Risks

While these risks exist, advancements in medical technology, skilled surgical teams, and improved postoperative care have significantly increased survival rates and reduced complications. Proper preoperative assessment, close monitoring, and follow-up care are essential to ensure the best outcomes for paediatric patients undergoing cardiac surgery.

Importance of Pre-Operative Preparation and Post-Operative Care

Surgery can be a stressful experience for both patients and caregivers. Proper pre-operative preparation and post-operative care play a crucial role in ensuring a smooth surgical process, reducing complications, and promoting faster recovery.

Recovery After Paediatric Cardiac Surgery

Recovery after cardiac surgery is crucial and requires close monitoring and care for optimal outcomes. Essential aspects for a smooth healing process include the type of surgery, the child’s health, and varying recovery times.

Immediate Postoperative Care (Hospital Stay)

After surgery, children are closely monitored in the Paediatric Intensive Care Unit (PICU). Some may need mechanical ventilation to help them breathe, medications are given to manage pain, and tubes are used to drain fluids and provide medications and nutrition through IV lines.

Transition to General Ward

After being stable, the child will be moved from the ICU to a general hospital ward. They will gradually increase their activity, start gentle activities, and be encouraged to sit up and move. Normal feeding will be resumed slowly, whether it’s breastfeeding, bottle-feeding, or solid foods. Parents will be guided on how to care for their child, including feeding, handling, and giving medication.

Home Care After Discharge

Of course adequate care at home is essential in ensuring proper recovery of your child. Here are some areas that you should focus on:

• Incision Care: Keep the surgical wound clean and dry. Watch for signs of infection such as redness, swelling, or discharge.
• Medication Adherence: Follow the prescribed medication schedule, including pain relievers, blood thinners (if needed), and antibiotics.
• Physical Activity Restrictions: Avoid strenuous activities, heavy lifting, or rough play for several weeks.
• Diet and Nutrition: Provide a well-balanced diet to support healing and overall growth.
• Emotional Support: The child may experience anxiety or mood changes. Comfort and reassurance from parents are crucial.

Follow-up Appointments

Regular visits to the paediatric cardiologist are important to monitor heart function. Various tests such as echocardiograms, ECGs, and X-rays may be done to track progress. Changes to medications or additional therapies may be suggested depending on how well recovery is going.

Long-Term Recovery and Outlook

After surgery, most children can resume normal activities within 4-6 weeks. Some may need cardiac rehabilitation or physical therapy. It is important to monitor them regularly for any complications or developmental issues. With proper medical care and family support, most children recover well from cardiac surgery and can lead healthy, active lives.

Tips for Parents and Caregivers During the Surgical Process

Here are some helpful tips for parents and caregivers to support their child through the surgical process:

Before Surgery

• Prepare Your Child – Explain the procedure in an age-appropriate way to reduce fear and anxiety. Use simple and reassuring language.
• Follow Pre-Surgery Instructions – Adhere to fasting guidelines and medication restrictions provided by the doctor.
• Pack Essentials – Bring comfort items such as a favourite toy, blanket, or book to ease your child’s stress.
• Manage Your Own Emotions – Stay calm and positive, as children can pick up on your anxiety.

During Surgery

• Stay Available – Be present in the waiting area and keep your phone handy for updates.
• Trust the Medical Team – Rely on the expertise of the doctors and nurses caring for your child.
• Take Care of Yourself – Eat, hydrate, and take breaks if needed to stay strong for your child.

After Surgery

Be patient with recovery – allow your child time to heal and provide reassurance.

• Follow Post-Op Care Instructions – Administer medications as prescribed and monitor for signs of complications.
• Create a Comfortable Environment – Arrange a cosy recovery space at home with everything they need.
• Encourage Communication – Let your child express any discomfort or fears and provide emotional support.

Summing it Up

Paediatric cardiac surgery is a lifesaving field that requires expertise, precision, and compassionate care. With various types of paediatric heart surgery, ranging from minimally invasive procedures to complex open-heart surgeries, children with congenital or acquired heart conditions now have a much-improved chance at a healthy life.

Expert paediatric cardiothoracic surgeons in Malaysia play a crucial role in providing world-class treatments and ensuring successful outcomes for young patients. While the journey may be challenging, advancements in medical science and supportive post-operative care offer hope and healing to families worldwide.

By staying informed and seeking the right medical care, parents can ensure their child receives the best possible treatment and recovery pathway, paving the way for a healthy and fulfilling life.

Sources:

• https://www.childrensnational.org/get-care/departments/cardiac-surgery
• https://medlineplus.gov/ency/article
• https://www.mayoclinic.org/departments-centers/pediatric-cardiac-surgery/sections/conditions-treated
• https://ufhealth.org/conditions-and-treatments/pediatric-heart-surgery