Treatment Options for Congenital Heart Disease

Surgery and hybrid procedures

Some congenital heart disease (CHD) conditions require repairs that can only be made through open-heart surgery. These repairs may be needed right away, or they may be delayed for months or even years. Sometimes, repairs can be made in a single surgical procedure, while other times, a series of operations may be needed. In addition, some repairs can be made with hybrid procedures involving both surgery and catheter-based interventional techniques. It all depends on the type and severity of the heart defect and how sick the patient is.

Surgery

If surgery is required, the patient’s medical team includes specialists with the training needed to treat the specific condition. If the patient is a child, the team may include a pediatric heart surgeon, a pediatric anesthesiologist, pediatric heart-lung pump technologists, pediatric surgical nurses and technicians, and pediatric intensive care physicians and nurses.

In general, heart surgery involves the following steps:

1. During surgery, the patient is placed under general anesthesia. Depending on the repair to be made, the surgeon may make an incision through the breastbone (sternum) and between the lungs or on the side of the chest between the ribs.
2. Sometimes, it’s necessary to stop the heart during the surgery in order to perform the repairs. If stopping the heart is necessary, the patient is placed on a heart-lung bypass machine, which takes over the work of the heart. It adds oxygen to the blood and keeps it circulating through the body during the surgery.
3. Depending on the complexity of the procedure, heart surgery for a patient may take up to 12 hours in the operating room.
4. After surgery, the patient is moved to the intensive care unit (ICU) and will stay there for several days of monitoring and treatment. During this time, the patient will have tubes to help with breathing; deliver fluids or medications directly into the veins; measure blood pressure; drain air, blood, and fluid from the chest cavity; empty the stomach; provide medicine and/or food; and drain the bladder.

Possible complications

Minor and major complications can result from open-heart surgery. Minor complications can include the following:

• Nausea and vomiting
• Minor infections
• Minor bleeding or bruising
• Abnormal or painful scar formation
• Allergic skin reaction to tape, dressings, or latex
• Skin numbness

Among the rare but more serious complications that can occur are a stroke, heart attack, other heart and lung problems, serious bleeding, kidney failure, nerve or organ damage, and an allergic reaction to medications.

Hybrid procedures

Hybrid procedures allow interventional cardiologists and cardiothoracic surgeons to bring their areas of expertise together to maximize these advantages and potentially minimize the disadvantages in the treatment of cardiac and vascular problems in children and adults. Actually, the philosophy of doing hybrid procedures is not that new; however, the increasing partnership of cardiologists and surgeons has opened new doors to allow more complex combined cardiac procedures to be performed than in the past. As such, hybrid procedures represent a natural evolution in the coordinated treatment for patients with CHD.

Many hospitals have incorporated this philosophy of partnership in the design of the operating rooms and catheterization labs so that hybrid procedures can be performed more successfully. Both the interventional cardiologist and cardiac surgeon have special requirements for doing their jobs successfully. For the interventional cardiologist, very good X-ray imaging, quick access to the many interventional supplies used, and the ability to review X-ray images at the bedside are crucial. For the surgeon, proper air cleansing/circulation in the room to minimize infections, good lighting to visualize the surgical field, and an unencumbered environment for the anesthesiologist and other operating room staff are equally important.

Examples of hybrid procedures include the following:

• Closure of ventricular septal defects (VSDs)
• Intraoperative vascular stent placement (surgical placement of a stent in a blood vessel)
• Hybrid first stage Norwood procedure for single ventricle heart disease
• Postoperative “exit angiography” after surgical repair of vessels in the operating room
• Valve placement without the need for cardiac bypass

Undoubtedly, new applications of operative and catheter-based techniques will continue to evolve, and hybrid procedures represent an exciting development in the treatment of CHD.