Open Heart Surgery below 6 month
Infants are sometimes born with various heart conditions that are either minor or major. Most healthcare facilities often suggest waiting until the baby is older before conducting an open heart surgical operation. However, the longer the child waits, the more susceptible they become to other health problems. Open heart surgery below 6 months is thus essential as it gives the newborns the best possible beginning in life.
Open heart surgery is the surgical procedure that surgeons conduct on the heart. It involves the placement of the heart-lung bypass machine to take charge of lungs and heart functions. This includes supplying oxygenated blood throughout the body.
Why is Open Heart Surgery Performed?
Pediatric surgeons normally recommend open heart surgery below 6 months to correct or repair various heart defects, which include;
- Atrial septal defects
- AV canals
- Tetralogy of Fallot
- Transposition of the major arteries
- Ventricular septal defects
These conditions usually involve using cardiopulmonary bypass, stopping the heart, as well as opening the heart. In general, most childhood cardiac procedures are open-heart operations.
What Does Open Heart Surgery below 6 Months Involve?
Open heart surgery involves opening up the chest to obtain access to the heart. To achieve this, the surgeon has to slice through the breast bone or sternum, a procedure known as a sternotomy. Since the skin may be extended to a certain degree, the skin incision is normally less than the breast bone length. On the other hand, the length of a repeat cut (a redo-sternotomy) is often slightly extended than the initial scar.
The major concern among most parents is about the perception of a sternotomy. They usually get surprised to learn that a sternotomy is one of the best and most convenient incisions during the surgical procedure. A sternotomy is nothing more than an artificial fracture. The final part of the operation involves reconnecting the two ends of the breast bone using steel wires. This typically does not result in any chest wall deformities with time as the child grows older. Also, a sternotomy procedure won’t stop the progression of pre-existing chest wall deformities.
The nerve endings of the impaired tissues detect pain. Pain in the bone is caused by movement at the area of the fracture. Normally, the infants do not have robust muscle mass in the chest wall to lift the sternal edges, hence causes discomfort. As a result, the majority of children are not unexpectedly sent off with only Tylenol and ibuprofen.
Following the chest opening, the surgeon removes a portion or the whole of the thymus gland. The thymus gland is associated with the immune system. Nonetheless, it has not been proven that eliminating it induces any immune compromise. The surgeon must remove the thymus in order to view and operate on the organ. Typically, a small, leathery sac known as the pericardium surrounds the heart.
The pericardial sac must be opened in order to gain access to the heart. The surgeon will also extract a small part of the pericardium to use later in repairing holes in the heart or enlarge the vessels through patching. The detached fragment is often addressed with a chemical known as glutaraldehyde to stiffen the pericardium. This makes it easy to deal with during the operation.
During the procedure, the detached pericardial fragment is used as a repair material for a number of defects and holes inside the heart. The pericardium that was taken does not require replacement.
How to Prepare the Child for Open Heart Surgery
Children who require open heart surgery have to undergo a complete examination by the pediatric cardiologist and surgeon. Mostly, the examination process involves blood work, electrocardiogram, chest x-ray, echocardiogram, and probably a heart catheterization. The information obtained from the evaluation guides the surgeon when performing the procedure and during perioperative care.
Ensure that you inform the baby's health care provider of the medications he or she is taking. This also includes the medications, herbs, and supplements purchased without the doctor’s prescription.
The child’s physician will recommend the following a few days before the open heart surgical procedure:
- If the infant is on blood thinners, medications that make it difficult for blood to clot, including heparin or warfarin (Coumadin), consult with the child's surgeon on whether to discontinue these medicines.
- Ask about the medications the child should continue taking during the scheduled day of the operation.
During the set day of the operation, you should expect the following;
- In most cases, the physician will ask you not to feed the child with drinks or food after midnight on the night before the operation.
- Giving the baby the medicine you've been advised to administer with a little sip of water.
- The doctor will advise you on time to arrive at the healthcare facility.
What Happens After Open Heart Surgery Below 6 Months?
Many children who undergo pediatric open heart surgery have to remain in the intensive care unit (ICU) for at least two to four days following the operation. They will also remain in the hospital setting for 5 to 7 days after leaving the ICU. On the contrary, those who undergo closed-heart surgery remain in the ICU and hospitals for shorter periods.
The child would have the following during their stay in the ICU:
- An endotracheal tube in the air path and a respirator to assist with the breathing process. When on the respirator, the child will remain sedated or asleep.
- One or more thin tubes inserted into a vein (IV line) to deliver fluids and medications.
- A tiny tube inserted into the artery (arterial line).
- One or two chest tubes to help drain oxygen, fluids, and blood from the thoracic cavity.
- A nasogastric tube inserted via the nose into the stomach to empty the stomach, administer medications and eat for several days.
- For a few days, a tube is inserted into the bladder to measure and drain the urine.
- Various electrical tubes and lines used to supervise the child’s body.
Most of the wires and tubes will have been removed by the time the child is discharged from the ICU. The physician will encourage the parent to allow them to perform normal activities. Others can start eating or drinking after a day or two, while some might take a bit longer.
Following the discharge of the child from the hospital, caregivers and parents are educated on the activities that are suitable for the baby. They are also taught how to take care of the incisions or cuts and ways of administering any drugs that the child may require. The child usually requires at least a few more weeks at home to recover.
After every 6 to 12 months, the child will have to see a cardiologist for follow-ups and checkups. To avoid chronic heart infections, your child should take antibiotics before seeing the dentist for cleaning the teeth and other dental procedures. You should, however, consult your cardiologist to know if this is appropriate.
The success of Open Heart Surgery below 6 Months
The success rate of open heart surgery below 6 months is mainly dependable on the specific defect being treated. The corrective procedures, including ventricular septal defect and atrial septal defect closure, are very effective, with almost zero mortality or death rate).
Lesions are somewhat more complex. However, the ones that are done regularly, including complex AV canal faults, tetralogy of Fallot, and transposition of the great vessels, have a chance of less than 5%. The most complicated lesions like single ventricles defects have increased risk ranging between 15 to 20%. This is because one of the valves or ventricles is underdeveloped or hypoplastic.
Other variables can have an effect on these outcomes. For example, a prematurely born infant with low birth weight and end-organ damage like liver injury or kidney failure has higher risks from open heart surgery.
Risks and Complications of Open Heart Surgery below 6 Months
Every open heart surgery is associated with various risks that arise due to cardiopulmonary bypass use. Cardiopulmonary bypass safety and convenience have considerably improved for the past few years. As a result, significant complications are now very uncommon. The bypass periods of up to four to eight hours are accepted well.
Overall, some of the possible risks the child can experience include;
- Negative reactions to medications
- Severe bleeding during or after the operation
- Breathing problems
- Infection on the surgical area
- Blood clotting
- Air emboli (air bubbles)
- Arrhythmias (irregular heart pulse)
- Heart attack
Open heart surgery below six months is the type of operation conducted on the infant’s heart. Based on the type of congenital condition to correct, the procedure involves opening the heart and performing the operation in a bloodless and calm site. The earlier the child undergoes the heart surgery, the higher the chances of living a better-improved life.
Basically, there are various types of heart defects. While some are mild, others tend to be more chronic. These defects can develop in the heart or on the major blood vessels located outside the heart. Although immediate surgery after delivery is essential, others should be conducted after several months or years for safety purposes. However, the child’s doctor will advise on the best alternative.