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Challenge: NICU Parenting

Heart Hole Surgery in Kids. Is it safe?

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Congenital heart diseases involving septal holes are pretty common among newborn babies. More than 2800 babies are born with defects in the atrial septum in the United States alone. The heart chambers, namely atria and the ventricles, are separated by valves or septum which regulate the amount of blood flow from one chamber to the next. Any kind of hole present in the heart shall lead to unregulated blood flow to the chambers or the lungs.

There are two types of heart hole detected among children, which are:

• Atrial Septum Defect
• Ventricular Septum Defect

Both the defects are extremely common among children, and require immediate medical attention. Among them, the Ventricular Septum Defect or VSD is more commonly diagnosed compared to that of ASD or Atrial Septum Defect. The safety and well-being of the infants depend on the diameter of the hole, extent of damage and risk factors attached. In cases of minor hole, the defects go undetected for a brief period of time until the child shows symptoms. The infant or the child may be exposed to conservative treatment until the hole heals itself. However, in severe cases, heart hole surgery needs to be performed with immediate effect.

a. What are the causes for heart hole surgery in Children?

The causes of heart hole among newborns vary to a great extent. In some children, sudden genetic mutations in the chromosomal pattern while the baby is still in the mother's womb, may cause formation of defective atrial or ventricular septum. In other cases, the heart fails to develop completely after birth due to which, a hole is usually left in either of the septum.

The causes for heart hole surgery in children depends on the diameter of the hole detected. In most of the severe congenital heart diseases, open heart surgery is required. However, in infants, it can be performed in infants among six months age to two years age. Hence, vsd surgery in kids is required, in case:

• The hole does not repair itself over time
• The hole detected is large enough to cause irregularities in the blood flow
• The VSD causes increased pressure build-up in the lungs
• Cardiac catheterization procedures fail to provide any relief

b. Is it safe for my child to undergo heart surgery?

VSD surgery in children is mostly safe with high success rates compared to other congenital heart anomalies. Heart surgery in this case is performed to ensure perfect closure of the diagnosed hole and to ensure complete prevention of the defect from recurring in near or far future. The surgical procedure, in most cases, involves minimum invasion and minor surgeries. However, in case the child is diagnosed with large VSD or has pre-surgical complications, then open surgery might need to be performed. Success rates in both the surgical procedures are high and does not pose any threat, unless any kind of complication arises.

c. What are the risks associated with heart surgery for children?

Children undergoing heart surgeries to cure congenital heart defects often require post-surgical therapies and conservative care. Most children also need to visit the cardiologist at regular intervals. Although VSD surgery in kids have high success rate and do not involve any major threats, yet complications may arise. This highly depends on the child’s bodily responses.

• Severe bleeding causing excess blood loss
• Breakage of suture that is used to block the defective hole
• Formation of blood clots that may cause blockage in blood circulation and cause strokes
• Infection. Though the candidate is provided with anti-infective drugs, a slight possibility of severe infections still remain
• Abnormal heart rate
• Ceasing of heart beat. In this case, the child may require assistance of pacemaker

d. What steps should I undertake for best recovery of my child post surgery?

Post-operative care is extremely necessary to ensure the best health of the child. Normally, the candidate is advised to take three to four weeks of bed rest after being discharged from the hospital. However, in extreme cases, the child might also be advised eight to ten weeks of thorough rest. The other steps which needs to be followed are:

• Mandatory follow-up visits for removal of stitches and routine checkups are extremely necessary and should not be missed
• Report in case of excess bleeding, or swelling in the region. However, faint bleeding is pretty common, especially after the removal of stitches (or in case the stitches are removed early)
• Medicines should be provided timely
• Do not overdo painkillers, as these can cause various other side-effects
• Always confirm from the doctor before allowing the child to resume physical activities
• Regular exercises are mandatory. Besides physical exercises, the child must practice regular breathing exercises to minimize any long-term side effect or complication while breathing
• Eating habits should be monitored, especially in the first few weeks.

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