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Home > Our Services > Conditions and Treatments > Surgery for Paediatric Congenital Heart Diseases

Surgery for Paediatric Congenital Heart Diseases

 

 


 

 

Overview

 

The following are some of the common paediatric heart surgical procedures.

 

Closed heart surgery: "heart lung machine" or "bypass" machine is not used and the heart is visualized but not cut open.

 

Open heart surgery: heart needs to be opened in order to repair the defect and therefore the "cardiopulmonary bypass (CPB)" machine is used to oxygenate and circulate the blood without using the heart or lungs. This bypass machine is used so that open heart procedures can be performed safely.

 

Examples of condition for Closed Heart Surgery:

  • Patent Ductus Aeteriosus (PDA)

 

 

  • Coarctation of aorta

 

  • Pallative Procedure ? Blalock Taussig Shunt

 

 

Examples of Conditions requiring Open Heart Surgery:

 

Septal Defects

  • Atrial Septal Defect

 

 

  • Ventricular Septal Defect

 

 

  • Atrio-Ventricular Septal Defect

 

 

 

Defects Causing Obstruction to blood flow

  • Pulmonary Stenosis

 

 

  • Aortic Stenosis

 

 

  • Tetralogy of Fallot
      • VSD
      • Over-riding aorta
      • Pulmonary Stenosis
      • Right Ventricular Hypertrophy

 

 

Defects involving the Great Arteries

  • Transposition of Great Arteries

 

Other Complex Lesions

  • Hypoplastic Left Heart Syndrome (Norwood Operations)

 

 

 

How does it affect my child's health

 

Presenting features depends on the age of your child and the type of defect present.

 

Common presenting features include:

  • Failure to thrive (inability to grow) in small infant/newborn
  • Cyanosis (blueness in nail-bed/lips in severe form, generalized duskiness in mild form)
  • Decrease in exercise tolerance
  • Breathlessness/Dizziness/Fainting episodes

 

If the condition is not corrected in timely manner, damage to the heart and/or lungs could get beyond repair and consequently limit the life span of your child.

 

 

How do I prepare my child for surgery

 

  • Your paediatric cardiologist will refer you and your child to a paediatric cardiac surgeon who will discuss with you about the planned surgical procedure
  • Depending on the urgency of the surgery, the discussion will either take place in an out-patient ward, or in the ward.
  • Once the surgical date is fixed, your child will be admitted a day prior to the planned procedure for pre-operative preparation (taking blood, chest x-ray, ECG etc)
  • The tests rule out any active infection or any other minor conditions that were not detected in previous investigations.
  • As a parent, you would need to prepare yourself psychologically. Should you prefer, you can request for a tour of the paediatrics intensive care unit to be arranged prior to surgery.

 

 

What happens during the surgery?

 

  • You will be allowed to accompany your child into the operating theatre (anaesthetic induction room).
  • You child will be injected with or inhale in an anaesthetic agent to put him/her to sleep.
  • Once your child falls asleep, you will be asked to leave the operating theatre.
  • The anaesthetist will then insert a breathing tube (Endo-tracheal tube) and various drips.
  • The time taken for the surgery would depend on the complexity of the procedure. It could take as fast as 1 hour to as long as 6 hours.
  • Parents should take note to get as much rest as possible because your child?s recovering period can be psychologically stressful. 
  • Once the procedure is successfully performed, you will be notified by one of the health professionals.
  • The surgeon will usually speak to you after the operation.

 

 

What are the potential risks or complications?

 

  • The surgical team will discuss in length what the possible risks and benefits of the operation are.
  • The benefits of the surgical intervention outweigh the risks.
  • The major risks includes: risk to life, neurological abnormality, arrhythmia (irregular heartbeat ? which sometimes may require insertion of a permanent pacemaker), renal dysfunction (may require dialysis ? temporary or very unlikely permanent), and bleeding or infection.
  • As a parent, you will be well informed of the risks and benefits of the surgery in advance.

 

 

What happens after the surgery?

 

  • Your child will be transferred to paediatric intensive care unit after the operation
  • There will be many tubes connected to your child for various purposes.
  • It is very important to cooperate with the paediatric ICU staff who are well trained, extremely caring and friendly
  • Usually a nurse will be assigned to solely look after your child during his/her stay in ICU.
  • As every patient is different, the staff will discuss with you regarding your child?s hourly/daily progress and treatment plans.
  • Your child may be kept in ICU for about 24-48 hours depending on the progress of his/her recovery.
  • When your child more stable,  he/she will then be transferred to High Dependency Unit (HDU) for further close monitoring for a period of further 24/48 hours until he/she is stable enough to be transferred to General Paediatric Ward.. 
  • At this stage, majority of the tubes and drips will be removed from your child?s body. 
  • Most of the recovery will be taken place in this general ward
    • he/she will be encouraged to move about and will be guided by physiotherapist. 
    • You can expect a period of 5-7 days in the general ward before the discharge depending on progress of recovery.
  • A thorough physical examination and various investigations ? ECG, Chest X-ray, 2D ECHO, will be carried out prior to discharge from the hospital.

 

Home care

 

  • After discharge, you will bring your child back for review by both the cardiologist and the surgeon.
  • At the fist review, within two weeks of the discharge, your child will be examined thoroughly ? wound review, and the medication will be altered.
  • Absorbable stitches are usually used for the big wounds for good cosmetic results.  The non-absorbable stitches are removed during the first review ? eg. Ex-chest drain site.
  • Your child will be then receive follow up reviews by a paediatric cardiologist at regular intervals (usually 2 weeks, 6 weeks, 3 months, 6 months, 12 months and annually after the discharge from the hospital)  and necessary investigations will be carried out during these follow ups.

 

 

When should you call the doctor?

 

Your child will most probably be walking/running around, eating and drinking well and pain free prior to his/her discharge. However, the surgical wound can sometimes get infected after discharge from the hospital.

 

You should contact the ward/doctors/nursing staffs to make an appointment for an earlier review

  • If you notice any ooze or redness from the surgical wound
  • Concerns regarding your child?s recovery at home

 

The review can be arranged as soon as possible so that you as a parent can be re-assured and any potential problems can be picked up well in advance.

 

 

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