Congenital Heart Defects Surgery
It's important for you to be as healthy as possible for the operation. During the two weeks before the day of surgery it's a good idea to keep away from people who have a cold or fever. If you develop a fever, cough or cold during that time, talk to someone on the cardiology or surgical team to decide if the operation should be delayed.
You will be seen for preoperative counseling and testing the week before the scheduled surgery. At that visit it may be possible to arrange a tour of the hospital. Common pre-operative tests include an electrocardiogram, echocardiogram, chest X-ray and blood testing.
Patients are usually admitted to the hospital the morning of the operation or the day before. How long your operation will take and how long you will need to be in the hospital depend on your heart condition and the operation that's being done.
Sometimes the operating schedule has to be changed unexpectedly because of an emergency. Try to be prepared for possible delays.
Topics Related to Surgery
Blood transfusions are often needed for heart operations. The amount of blood required depends on the procedure. All blood donations are carefully screened to match your blood type and to rule out infections, such as HIV/AIDS and hepatitis. Blood is sometimes in short supply, so it's always appreciated when family members and friends give blood to the blood bank to replace the blood you use. It can be difficult to arrange to give you the same blood friends and family donated, but if you'd like more information about arranging donor-directed blood transfusions, contact your cardiac surgeon's office.
In the Operating Room
A team that includes the cardiac surgeon, anesthesiologist, other physicians, perfusionists, technicians, nurses, nurse practitioners and physician assistants will perform the heart surgery. While the surgeon performs the operation the anesthesiologist gives you anesthesia and monitors the vital signs.
The team will use a heart-lung machine, which is also known as a cardiopulmonary bypass machine, during open-heart surgery. The heart-lung machine allows the blood to bypass the heart so the heart can be emptied, opened and repaired. The bypass machine removes the bluish blood before it enters the heart, pumps it through a machine that adds oxygen to it and makes it red again, and then pumps the red blood back into the body.
Once the heart-lung machine is working and the heart is emptied, the team will give you a medication to stop the heart from pumping. The surgeon can then open the heart and do the operation. After the surgeon finishes the operation, he or she will close up the heart is close, allow the blood to fill the heart and start the heart's pumping. Once the heart is pumping normally, the team will turn off and disconnect the heart-lung machine.
Some operations on the blood vessels next to the heart don't need the heart-lung machine. These types of operations are called closed-heart surgery.
In the Intensive Care Unit
After surgery you will go to the intensive care unit (ICU). Specially trained doctors, nurses and technicians will give you round-the-clock care.
Your doctor may do blood tests, electrocardiograms, echocardiograms and chest X-rays to monitor your heart function. You may also receive intravenous medications to increase your blood pressure or heart rate or to allow the body to get rid of extra fluid that builds up during open-heart surgery. You will be kept as comfortable as possible with pain medications and sedatives.
Common types of monitoring and support used in the ICU include:
- Central venous line (CVL, CVP or right atrial line): A small tube, called a catheter, that's used to give medications, fluids and to monitor the pressure in your veins. The tube is placed directly into the heart through the chest wall or through one of the large veins in the body.
- Arterial line (Art line): A catheter that allows your child's blood pressure to be measured continuously. The tube is commonly placed into an artery in the wrist, groin or feet.
- Arterial Blood Gas (ABG): A test in which blood is drawn from the arterial line, it gives information about how well the lungs and heart are working.
- Oxygen Saturation (Sat monitor): A small monitor attached to the finger or toe that allows the oxygen level in the artery to be monitored continuously.
- Mechanical ventilator (breathing machine): This delivers oxygen to the lungs until you wake up from the operation and can breathe normally. The ventilator delivers oxygen to the lungs through a special tube called an endotracheal tube that's placed down the throat into the windpipe.
- Continuous Positive Airway Pressure (CPAP): This special device is placed in your nostrils to deliver oxygen under pressure. This can keep the lungs expanded without the use of a mechanical ventilator.
- Nasal Cannula: Small tubes placed into your nostrils that deliver oxygen into the lungs.
- Chest tube: A tube that's placed through small incisions in the chest wall into the space around the heart or the lungs to drain fluid and air produced by the operation. You may have one or more chest tubes. Your doctor will remove the tubes once the air and fluid drainage goes away.
- Foley catheter: A tube that's placed into the bladder to drain the urine continuously and make sure your kidneys are working properly.
- Pacing wires: Small wires that are placed through the chest wall and attached directly to the heart. If you have an abnormal rhythm, these wires can restore the heart's normal rhythm.
Further Hospital Care
After leaving the ICU, you will go to a less intensive area of the hospital, often called "the floor" or "step-down unit." In these areas your heart rate and rhythm may still be monitored using a continuous electrocardiogram system called telemetry. You will participate in a program that encourages coughing and deep breathing to help prevent lung collapse and infection. Engaging in normal activities, like walking and going to the bathroom will help speed your recovery.
After surgery some patients eat a low-salt diet to reduce the buildup of fluids in the body. Your cardiologist may also prescribe medications such as diuretics, digoxin or antibiotics. You may need to take these medications for a period after you have left the hospital.
Some patients may have a fever for the first few days after the operation. Fever can be a normal reaction to the surgery, but if the fever doesn't go away, your doctors may run tests to find out the cause and how to treat it.
At first, you may need pain medication, but pain often goes away within only a few days after the operation.
As you get better after heart surgery, you will begin to take your medications by mouth instead of through an IV. Your doctor will wean you off oxygen and remove special central lines.
When the doctors are satisfied that you are getting better, it will be time to go home. They may take a chest X-ray, echocardiogram and electrocardiogram before they discharge you to check the results of the surgery. You may be given pain medications or heart medicines to take at home. The doctor will give you instructions on how and when to give these medicines; be sure you understand all your medications before you leave the hospital. Your cardiologist or surgeon may stop or adjust your medications when you return for your post-operative visit.
Taking Care of Your Child at Home
The surgical team will give you instructions about wound care and activity levels for your child after your child is discharged. In general, the chest incision should be kept clean and dry. Most children will be allowed to take a quick shower or sponge bath followed by gentle towel drying of the incision. Swimming or soaking in a bathtub is usually not permitted for at least a few weeks after surgery. Usually children can participate in regular household activities, but they should avoid any rough, vigorous play or sports until your doctor permits.
School-age children usually are kept home from school for several weeks after the operation. Your doctor will tell you when your child can return to school and to gym class and sport activities.
You should call your surgeon or cardiologist if your child develops fever, chest pain, trouble breathing; or redness, swelling or pus at the incision site.