The human heart is roughly the size of a folded fist, and, in those terms, the baby's heart is the size of a half-blooming rose and must be handled with care, like the rose's petals. 'Operating on Cheese', that’s how it feels to touch and hold and operate on the heart of newborn babies.
Why is this needed?
1 in 5000 babies are born with critical congenital heart disease that requires early surgery, sometimes as early as the day they are born or within the first few weeks of life.
Medical treatment alone does not correct the defect and all children need surgery. Common diagnoses include Transposition of the Great Vessels (TGA), Total Anomalous Pulmonary Venous Connection (TAPVC), Interrupted Arch, Neonatal Coarctation, Truncus Arteriosus, Pulmonary Atresia, and Neonatal Ebstein’s.
Signs:
Parents can suspect heart disease when the baby is blue, has poor feeding, breathing difficulties, cold extremities, or is unresponsive. In a hospital, the doctors identify the exact nature of the problem by performing an echocardiogram.
Neonatal pulse ox screening is an excellent method for identifying these defects with a saturation of less than 90, which suggests a high suspicion of heart disease.
It is important that parents know what is happening to their children and how treatment is going to help them. To explain some of the common defects, in TGA, the aorta (the vessels that supply blood to the body) and the pulmonary artery (the artery that supplies blood to the lungs) come out from the wrong chambers and need to be ‘switched back’. The surgery, therefore, is called Arterial Switch.
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In the defect known as TAPVC, the veins that bring back purified blood from the lungs drain into the right side of the heart instead of the left side. This needs to be directed back to the left side of the heart or ‘re – routed’.
Interrupted arches and neonatal coarctations are disconnections/narrowing of the aorta that reduce the blood supply to the body and for these, the narrow portions need to be removed and re- sutured.
In Pulmonary Atresia, the blood vessel supplying the lungs is not developed, and we need to create new sources of blood flow to the lungs.
In select cases, catheter-based interventions such as Balloon Atrial Septostomy, also known as BAS, or Ductal stenting may be needed to buy time to stabilise the child's circulation before performing life-saving surgery. Pediatric cardiologists do these procedures in the Cath lab or at the bedside.
Surgeries are usually performed by the Pediatric Cardiac surgeon, who cuts through the breastbone or the side of the chest to repair the heart. The heart is usually stopped for a bloodless field. During this time, circulation and oxygenation are maintained by the heart-lung machine.
Invasive lines for monitoring pressures, pacing wires for maintaining heart rate, and chest tubes are placed for use during the stay in the Intensive Care Unit. The pediatric cardiac anaesthetist ensures that the babies are sedated during the procedure, so that they do not feel the pain.
Some of these babies are preterm and are of lower birth weight, and their tolerance to undergo a complex surgery is limited. Their body’s ability to fight infection is also underdeveloped. This prolongs the postoperative recovery.
The average hospital stay is often weeks and at times can take months for a slow but sure recovery. Once this crucial period is overcome, many of these children grow up normally with a quality of life equal to that of children who do not have heart diseases. Therefore, treatment should be offered to all babies when a heart defect is detected.
The author is a Senior Consultant at the Department of Pediatric Cardiac Surgery, KIMSHEALTH, Thiruvananthapuram.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
