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Surgical treatment of congenital heart defects for premature babiesSSurgical treatment of congenital heart defects for premature babiesSurgical treatment of congenital heart defects for premature babiesEnglishNeonatology;CardiologyPremature;Newborn (0-28 days);Baby (1-12 months)HeartCardiovascular systemProceduresPrenatal Adult (19+)NA2009-10-31T04:00:00ZPatrick McNamara, MB, BCh, BAO, FRCPC12.000000000000054.00000000000001278.00000000000Flat ContentHealth A-Z<p>Learn about various surgical treatments available for the premature infant suffering from congenital heart defects.</p><p>In addition to monitoring and drug therapy, the negative effects of a heart defect may be reduced or possibly, near eliminated through surgery. The types of surgery and typical outcomes of surgical procedures vary depending on the specific heart defect. </p><h2>Key points</h2> <ul><li>The types of surgery and the typical outcomes will vary depending the specific heart defect a baby has.</li> <li>A baby's size and weight must reach a certain point before surgery can be performed.</li> <li>Types of surgical procedures include palliative surgery, cardiac catheterization, balloon angioplasty, arterial switch procedure, Bialock-Taussig (BT) shunt, and Norwood procedure.</li></ul>
Traitement chirurgical pour les cardiopathies congénitales aux bébés prématurésTTraitement chirurgical pour les cardiopathies congénitales aux bébés prématurésSurgical treatment of congenital heart defects for premature babiesFrenchNeonatology;CardiologyPremature;Newborn (0-28 days);Baby (1-12 months)HeartCardiovascular systemProceduresPrenatal Adult (19+)NA2009-10-31T04:00:00ZPatrick McNamara, MB, BCh, BAO, FRCPC12.000000000000054.00000000000001278.00000000000Flat ContentHealth A-Z<p>Renseignez-vous sur les différents traitements chirurgicaux offerts aux bébés prématurés souffrant de cardiopathies congénitales.</p><p>En plus du contrôle et de la pharmacothérapie, il est possible de diminuer les effets négatifs d’une cardiopathie, voire les éliminer à l’aide d’une chirurgie. Le type de chirurgie et les résultats habituels des interventions chirurgicales varient selon la cardiopathie particulière. </p><h2>À retenir</h2> <ul><li>Le type d’intervention chirurgicale et les résultats habituels de cette intervention varient selon la malformation cardiaque du bébé.</li> <li>La taille et le poids du bébé doivent atteindre un certain point avant que l’on puisse entamer des interventions chirurgicales.</li> <li>On compte parmi les types d’interventions chirurgicales l’intervention chirurgicale palliative, le cathétérisme cardiaque, l’angioplastie par ballonnet, la détransposition, l’anastomose de Bialock-Taussig et l’intervention de Norwood.</li></ul>

 

 

Surgical treatment of congenital heart defects for premature babies1841.00000000000Surgical treatment of congenital heart defects for premature babiesSurgical treatment of congenital heart defects for premature babiesSEnglishNeonatology;CardiologyPremature;Newborn (0-28 days);Baby (1-12 months)HeartCardiovascular systemProceduresPrenatal Adult (19+)NA2009-10-31T04:00:00ZPatrick McNamara, MB, BCh, BAO, FRCPC12.000000000000054.00000000000001278.00000000000Flat ContentHealth A-Z<p>Learn about various surgical treatments available for the premature infant suffering from congenital heart defects.</p><p>In addition to monitoring and drug therapy, the negative effects of a heart defect may be reduced or possibly, near eliminated through surgery. The types of surgery and typical outcomes of surgical procedures vary depending on the specific heart defect. </p><h2>Key points</h2> <ul><li>The types of surgery and the typical outcomes will vary depending the specific heart defect a baby has.</li> <li>A baby's size and weight must reach a certain point before surgery can be performed.</li> <li>Types of surgical procedures include palliative surgery, cardiac catheterization, balloon angioplasty, arterial switch procedure, Bialock-Taussig (BT) shunt, and Norwood procedure.</li></ul><p>A baby’s size and weight must reach a certain point before surgical procedures can be undertaken. Heart surgery requires a certain amount of strength to recover from. Additionally, it may be necessary to put a baby on extracorporeal membrane oxygenation (ECMO) during and possibly after a surgical procedure. ECMO is a machine that resides outside the body that takes over both heart and lung function.</p><p>It should be noted that all surgeries carry risks. The risk to any individual undergoing a surgical procedure depends on the type and complexity of the surgery, and the type and severity of the defect.</p><h2>Types of surgical procedures</h2><h3>Palliative surgery</h3><p>Palliative surgery refers to procedures where complete repair of the heart defect is not possible and blood flow is controlled either with a shunt or an artificial tube implanted in the heart or with only one ventricle of the heart. Babies who have palliative heart surgery may have reduced heart function, meaning that oxygen delivery will remain at lower levels than normal. Babies with these types of conditions can live a long time, though as they grow their lifestyle will not be able to be as active as children and adults with normal hearts. Others with these conditions may not survive or may not live a long life.</p><h3>Cardiac catheterization</h3><p>Cardiac catheterization is a procedure in which a thin flexible tube called a catheter is passed into the heart and its surrounding blood vessels. Cardiac catheterizations can be used in 2 ways: to gather information, called diagnostic catheterization, and for treatment also called interventional catheterization.</p><p>Through a tiny incision in the arm, neck, or groin, the catheter is inserted into a blood vessel (artery or vein) and directed into the heart by real-time X-ray imaging, or fluoroscopy. The catheters are used for blood sampling, pressure measurements, dye injection (angiogram), and to repair specific areas of the heart and the surrounding blood vessels.</p><p>Cardiac catheterizations are performed on people of all ages, from babies to adult with. Sedation varies from local anaesthesia only to general anaesthesia depending on the type of procedure. The procedures are done in the cardiac catheterization lab, which looks like a small operating room.</p><h3>Balloon angioplasty</h3><p>When any part of the heart's circulation system becomes narrowed, balloon angioplasty, which is also known as balloon dilation, can help open up the narrowed area and improve blood flow.</p> <figure> <span class="asset-image-title">Balloon dilation</span><img src="https://assets.aboutkidshealth.ca/akhassets/Catheter_balloon_MED_ILL_EN.jpg" alt="" /><figcaption class="asset-image-caption">A catheter with a balloon on the tip is passed into the heart, where it is inflated to open up a narrowed area or widen an existing hole.</figcaption> </figure> <p>Thin tubes called catheters are inserted into the blood vessels in the groin at the top of the leg. X-ray pictures and measurements of the narrowed area are usually taken. A catheter with a balloon on its tip is threaded through the first catheter to this narrowed area. Once the balloon reaches the right place, it is blown up to open up the narrowed area. The balloon forces the narrowed area open and stretches the artery wall. The balloon is deflated, the catheters are taken out, and the entry site on the leg is covered with a bandage. Sometimes a stent, a type of wire mesh tube, is inserted to help keep the newly opened area open.</p><h3>Arterial switch procedure</h3><p>An arterial switch procedure can be an option for babies who have defects known as transposition of the great arteries (TGA). With this defect, the positions of the vessels that take blood away from the heart to the lungs and the body are switched. This means that blood that already has oxygenflows to the lungs, while blood that needs oxygen flows around the body. As one can imaging, this defect, of which there are several variations, deprives the body of oxygen and is very serious, sometime fatal.</p><p>An arterial switch procedure, usually performed within the first few weeks of life, is done to correct the blood flow. This open heart procedure involves “switching” the pulmonary artery and the aorta back to their normal positions and attaching the coronary arteriesto the new aorta in the correct positions.</p><p>Before the surgery is performed, a drug called prostaglandin will be given to keep the ductus arteriosus open to improve circulation. Another temporary procedure that can help mixing of the blood is a balloon atrial septostomy, which puts a hole or opening between the left and right atria. This is a temporary measure until the child is old enough for surgeryto establish normal blood circulation.</p><p>Following surgery in the long-term, the large vessels may become narrow, requiring balloon dilatation or another surgical procedure. In addition, the coronary artery which must be reimplanted to its new site may become deformed, resulting in reduced blood flow to the heart. It's also important to protect against bacterial endocarditis, which can occur after surgery.</p><h3>Blalock-Taussig (BT) shunt</h3><p>Blalock-Taussig shunts, or "BT Shunts," are used for defects that affect the flow of blood from the right ventricle, through the pulmonary artery, and to the lungs. These include pulmonary atresia, pulmonary stenosis, tricuspid atresia, and tricuspid stenosis.</p><p>Also called the blue baby operation, it is a palliative procedure since it doesn't correct the defect but helps to resolve symptoms until the child is older and/or the defect itself can be repaired.</p><p>A shunt is a small tube made out of synthetic material called Gore-Tex. The shunt attaches a section of the aorta to the pulmonary artery, creating a sort of detour. This allows the blood, a mix of oxygenated and de-oxygenated blood, to pass through the lungs again and pick up more oxygen.</p><p>The shunt mimics the role of the ductus arteriosus and is often put in place after the ductus closes naturally. The shunt improves the function of the heart, lets more blood flow to the lungs to become oxygenated, and relieves any cyanosis or blueness the child might have been experiencing. Shunts are usually used for four to five months until the child outgrows them and a second operation or definitive repair is needed.</p><h3>Norwood procedure</h3><p>The Norwood procedure, is used for babies with only one pumping chamber in their heart and other single ventricle defects.</p><p>The Norwood can be done as part of a series of surgeries. It involves reconstructing the aorta using the pulmonary artery to allow the ventricle to easily pump blood out to the body. It also involves placing a BT Shunt to maintain blood flow to the lungs and inserting a Bi-Directional Glenn Shunt. The final step is the fenestrated Fontan.</p><p>The risks involved with the Norwood procedure are high. This is a major and complex operation requiring expert care before, during, and after the operation. The teamwork among cardiology, cardiac surgery, anesthesia, critical care, and all other supporting staff is intense. Mortality can be as high as 20% even at the best centres. The potential for complications is also high.</p><p>After the initial Norwood operation, the heart is fragile and the flow of oxygen to the lungs is completely dependent on the BT shunt. The risks associated with the BT shunt include the potential for clots to develop in the shunt. Children also need to be on a blood thinner called heparin.</p><p>Once a baby has recovered from the first procedure two other procedures: the Glenn, or second stage, and the Fontan, or third stage, may also be performed. The long-term outcomes of this third procedure is not well known, since the oldest individuals who survived this operation are now only in their 20s.</p><p>More information</p><ul><li> <a href="/Article?contentid=1767&language=English">Congenital heart defects in premature babies</a></li><li> <a href="/Article?contentid=1604&language=English">Diagnosis of congenital heart defects in premature babies</a> </li><li> <a href="/Article?contentid=1840&language=English">Drug treatment of congenital heart defects in premature babies</a> </li></ul>https://assets.aboutkidshealth.ca/akhassets/Catheter_balloon_MED_ILL_EN.jpgSurgical treatment of congenital heart defects for premature babies

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