Pediatric cardiac surgery deals with the surgical treatment of heart disease in newborn babies.
Pediatric cardiac surgery interventions on newborns require great precision because the tissues are very fragile and the heart is tiny. In fact, a baby has a heart only as big as lime, and a heart valve has a diameter of ½ cm.
A field requiring zero tolerance for error
One of the significant difficulties of pediatric heart surgery is that it requires absolute precision. The same is true for more complex procedures such as the transposition of large vessels, for example when the aorta is in the position of the lung and vice versa, where it is necessary to re-implant the coronary arteries that have a diameter of a few millimetres, with a work of high precision that requires a great dedication.
The aortic valve is located at the exit of the left ventricle and, by closing, prevents blood from returning back into the heart during ventricular relaxation. The aortic valve can be born diseased (congenital pathologies) or get diseased during a person’s life (acquired pathologies).
It can narrow and hinder blood flow. Consequently, the exit of blood from the heart is insufficient and causes regurgitation of blood. This leads to fatigue of the left ventricle, with increasingly serious consequences.
Unlike the adult, the child is often too small to accept the prosthesis. Furthermore, the child will become an adult, with progressive growth of the whole body, including the heart: in other words, the heart will grow, and the valve will, therefore, remain too small.
The replacement surgery of the aortic valve, in the pediatric age, is therefore disadvantageous considering the child’s growth and the necessity of a life dependent on drugs. If, on the other hand, a biological valve is used, it will not be necessary to take medicine, but its duration over time will be significantly lower, making a further replacement necessary.
Pediatric cardiac surgery – emotional stress for parents
Pediatric cardiac surgery has made such progress over the past 25 years that overall operative mortality is less than 5%. Survival of children with congenital heart disease is 90% for complex heart disease and ≥ 98% for simple cases.
Preparing a child for heart surgery is a challenge for the whole family. Just like the affected child, parents and siblings need support and information to help them cope with the situation. The concepts used for psychological preparation for surgery differ not only from country to country but also from clinic to clinic. All the medical clinics in India provide full support and guidance from counsellors and psychologists.
Open heart surgery on an infant is a nerve-wracking situation for all family members. After all, parents do not know what to expect before, during and after their child’s surgery. Instead, the whole situation presents the parents themselves with an emotional challenge, so they often do not know how to help their child cope with what is happening.
One of the most worrying situations for parents is the moment when they have to leave their child alone at the entrance to the operating room. Most children undergoing cardiac surgery are in a reasonably stable physical condition if the procedure is not an emergency. But just when a child looks perfectly healthy on the outside, the relatives sometimes have difficulty understanding the need for surgery – especially as the parents are well aware of the risks of surgery.
For this reason, almost all parents want to visit their child as soon as possible in the intensive care unit after the procedure. Knowing the critical condition of one’s own child and the need to use different tubes and artificial respiration can create overwhelming fears among parents. The medical staff should be mindful of all these feelings and fears and ensure that relatives feel well informed about the condition of their child at all stages of the operation.
Best pediatric cardiac surgeons in India
Since the outcome of the operation has to be assured the parent must take help from the best pediatric cardiac surgeons in India has to offer. Several pediatric surgeons in India have undergone several years of training abroad and are very well known in their field. Some of them are –
- Dr Savitri Shrivastava at Fortis Escorts Heart Institute, New Delhi
- Dr Mahadev D. Dixit at Aster CMI Hospital, Bangalore
- Dr Sathyaki Purushotam Nambala at Apollo Hospital, Delhi
- Dr.Suresh Rao at Kokilaben Dhirubhai Hospital, Mumbai
- Dr Mrinalendu Das at Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata