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Paediatric Cardiac


Children born with heart defects (congenital heart defects) and heart diseases after child birth needs paediatric cardiac surgery. This surgery deals with closed and open heart surgeries. A procedure without the heart lung machine is called closed heart surgery. These surgeries are very complex, demanding and needs great efficiency as it deals with very small and fragile children and newborns with a bleak margin of safety. There are minor and more serious heart defects in children that can occur inside the heart or in the large blood vessels outside the heart. Some defects need surgery immediately after the baby is born and some others can be done safely after few months or years. In most cases only one surgery may be enough to repair the defect of heart but in case of serious disease a series of procedures is needed.

Congenital heart defects are the most common when the heart or blood vessels do not develop normally in utero.

There are many types of congenital heart defects among the children that may include:

1. Shunt lesions or hole in the heart – being the most common defect in which the muscular wall (septum) separating the chambers of the heart at the bottom (right and left ventricles) doesn’t fully developed. This can allow the oxygen rich blood to leak into the blood chambers with poor oxygen in the heart. Smaller holes can get closed on its own but big ones needs device closure or surgery.

2. Atrial septal defect (ASD) – a hole in the septum which separates the upper chambers of the heart and allows oxygen rich blood to chambers poor in oxygen.

3. Ventrical Septal Defect (VSD) – The hole in the septum separating the two lower chambers of the heart. The oxygen rich blood gets pumped back to the lungs instead of out to the body pressuring the heart pump harder.

4. Patent Ductus Arteriousus (PDA) Closure – occurs when the ductus srteriosus, a temporary blood vessel doesn’t close after the birth which can cause enlarge heart and elevated lung pressure. In rare cases, it can also go undetected until adulthood when patient experiences symptoms like heart palpitations, breathlessness, and pulmonary high blood pressure. Most of the patent ductus arteriousus can be treated with minimally invasive devise closure.

5. Artioventricular (AV) Canal Defect –are of two types: complete and partial. The complete form is a amalgamation of various closely related heart disease resulting in large defect in the centre of the heart that affects all four chambers. This problem allows extra blood to flow to the lungs and causes enlarge heart muscles and overwork. 6. Transposition of the Great Arteries (TGA) - The two main arteries leading out of the heart, the pulmonary artery and the aorta, are switched in position. This defect is present at birth.

7. Pulmonary Stenosis - In this heart defect, the valve protecting the pulmonary artery is narrow or doesn’t open fully causing the turbulent jets of blood entering the artery. It can leads to ventricular failure. Many patients of this defect can be treated by Balloon Pulmonary Valvuloplasty, a minimally invasive interventions where the valve opened up by specially designed balloons in the cathlab.

8. Aortic Valve Stenosis - This valve abnormality is on the left side and is quite similar to the pulmonary stenosis but can be more dangerous as the blood vessel carries blood to the whole body. Specially designed balloons in the cathlab can help in opening the valve and patient should regularly follow up and may require surgery (valve repair/replacement) in the long run.

9. Mitral Regurgitation -This is one of the most common valve diseases conditions called valve prolapsed. The mitral valve which guards the blood flow leaks the blood back to the left atrium and causes extra load leading ultimately to heart failure. For severe leak, the valve has to be either repaired or replaced. Surgeon should be very skilled and has expertise in repairing the mitral valve to avoid the replacement of the valve or need for blood thinners. 10. Aortic Regurgitation - in this problem, the blood leak back from the aorta to the left ventricle, causing the left ventricle to dilate and if not treated leads to left ventricular failure. Bicuspid aortic valve, Marfan syndrome, and rheumatic heart disease are the various conditions which can cause this defect. Surgeon will suggest the treatment to repair or replace the valve.

10. Aortic Regurgitation - in this problem, the blood leak back from the aorta to the left ventricle, causing the left ventricle to dilate and if not treated leads to left ventricular failure. Bicuspid aortic valve, Marfan syndrome, and rheumatic heart disease are the various conditions which can cause this defect. Surgeon will suggest the treatment to repair or replace the valve.

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