• Stenosis – narrowing
• Atresia – absence of
• Atrium and Ventricle - there are 4 chambers in the heart; both right and left having 2 each, one sitting above the other. The top chamber is called an atrium while the bottom chamber is called the ventricle.
• Mitral valve – this is the opening between the top and bottom chambers in the left side of the heart – act as one way valve
• Tricuspid valve – this is the opening between the top and bottom chambers in the right side of the heart – act as one way valve
• Aortic valve – this is the opening that connects the left ventricle of the heart with the aorta, which is the major blood vessel that delivers oxygenated blood to the rest of the body – act as one way valve
• Pulmonary valve – the valve in the opening the connects the right side of the heart to the vessels that deliver the used, oxygen depleted blood to the lungs – act as one way valve
• Septum – the wall that divides the right and left sides of the heart; the wall that divides both the atria is called the atrial septum and the wall that divides both the ventricles is called the ventricular septum

There are many different types of CHD that fall into four common categories of congenital defects:

1. Obstruction to blood flow

• Tetralogy of Fallot (TOF)
• TOF has 4 abnormalities which are:
• VSD
• Over-riding of the aorta
• Pulmonary stenosis
• Right ventricular hypertrophy
• Pulmonary atresia with intact VSD
• Pulmonary atresia with VSD
• Tricuspid atresia
• Ebstein's anomaly

4. Complex cyanotic defects

Medical and surgical treatments now offer these children an opportunity to grow and mature into adult life, an option that was not available in the past once.

• Antenatal (before a child is born) diagnosis when a fetal cardiologist detects CHD during regular check-ups before the child is born. 
• If this is the case, plan of management and appropriate treatment can be fully discussed and planned with the parents before labour.  
• After the child is born when diagnosis is made soon after birth due to abnormalities detected in routine tests e.g.
• Abnormal (or low) oxygen saturation measurements 
• Presence of heart murmurs during physical examination
• Other defects may only be diagnosed later on in the child's life.

• Electrocardiogram (ECG)
• 2-D echocardiogram (ECHO)  
  
• Cardiac catheterisation
• Cardiac magnetic resonance imaging (CMRI)

How does it affect my child’s health? 

The presenting features of CHD depend on the age of your child and the type of defect present.

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

• Hours after birth e.g. in total anomalous pulmonary venous drainage
• Within a few days e.g. in transposition of great arteries

• Putting in a temporary shunt to redirect the blood flow so that your child can grow bigger and stronger before carrying out a definitive procedure e.g. Tetralogy of Fallot 

• The chest cavity and the heart need to be opened in order to repair the defect.
• This requires a "cardiopulmonary bypass (CPB)" machine during the surgery to oxygenate and circulate the blood without using the heart or lungs allowing the safe performance of the open heart surgery.

• Your paediatric cardiologist will refer you and your child to a paediatric cardiac surgeon who will discuss with you the planned surgical procedure.
• Depending on the urgency of the surgery, the discussion will either take place in an out-patient clinic or in the ward.
• Once the date for surgery is fixed, your child will be admitted a day prior to the planned procedure for pre-operative preparation such as:
• Taking blood for routine tests
• Chest X-ray
• ECG
• 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. Discuss with your child’s surgeon of any concerns that you may have.
• Should you prefer, you can request for a tour of the paediatrics intensive care unit to be arranged prior to surgery.

• You will be allowed to accompany your child into the area in the operating theatre where the anaesthetic doctor will prepare your child to receive general anaesthesia.
• 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 (endotracheal tube) and put in various drips – central venous cathether, arterial cannula, intravenous cannula.
• The time taken for the surgery would depend on the complexity of the procedure. It could last from an hour to as long as 6 hours.
• 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.

• The surgical team (paediatric cardiac surgeon and anaesthetist) will discuss the surgery in length with you. This includes the possible risks and benefits of the surgery.
• If surgery has been recommended for your child, this means that the doctors have good reason to believe that the benefits of the surgical intervention outweigh its risks.
• The major risks include: 
• Risk to life
• Neurological abnormality
• Arrhythmia (irregular heartbeat) that may sometimes require insertion of a permanent pacemaker 
• Abnormality of the kidney function that may require temporary dialysis and very rarely permanent dialysis
• Bleeding during or after the surgery
• Infection of the wounds

• Your child will be transferred to the paediatric intensive care unit (PICU) after the operation.
• There will be many tubes connected to your child for various purposes, so do not be alarmed.
• Your child will usually be under deep sedation (asleep) usually for up to 24 hours or longer after surgery, depending on the complexity of the surgery and the age of the child.
• It is important to cooperate with the paediatric ICU staff who are well trained, caring and friendly.
• Usually a nurse will be assigned to look after your child solely during his/her stay in ICU.
• As every patient is different, the staff will discuss your child’s hourly/daily progress and treatment plans.
• Your child may be kept in the ICU for about 2 days depending on his/her recovery progress.
• When your child is stable, he/she will then be transferred to a high dependency unit (HDU) for further close monitoring for another 1-2 days until he/she is stable enough to be transferred to the general paediatric ward.
• At this stage, most of the tubes and drips will be removed from your child’s body. 
• Most of the recovery will be taken place in the general ward:
• He/she will be encouraged to move about and will be guided by a physiotherapist.
• Depending on the recovery progress, you can expect a period of 5-7 days in the general ward before your child is discharged from the hospital.
• A thorough physical examination and various investigations will be carried out prior to discharge. These tests are:
• Blood Tests
• ECG
• Chest X-ray
• 2-D ECHO
• During your child’s recovery period, the parents are encouraged to get as much rest as possible. Once the child is discharged  from the hospital, you will be solely looking after child at home. This can be physically demanding and mentally challenging. 

• After discharge, your child will be required to see both the cardiologist and the surgeon for review.
• At the first review, which is within two weeks of the discharge, your child will be examined thoroughly including a wound review and his/her medications will be reviewed and may be changed depending of how he/she is doing.
• For good cosmetic results, absorbable stitches are usually used for the large wounds. However, for the smaller wounds (e.g. the site where the chest drains were inserted after the surgery), non-absorbable sutures are used and these will be removed during the first review.
• Your child will 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 discharge from the hospital) and necessary investigations will be carried out during these appointments.

• Pain free
• Walking/running around
• Eating and drinking well
• Good Bowel Movements.

• Notice any ooze or redness from the surgical wound
• Have concerns regarding your child’s recovery at home