HEART SURGERY CONGENITAL DEFECTS RESULTS

Before surgery for congenital heart defects, the patient will receive a complete evaluation, which includes a physical exam, a detailed family history, a chest x ray, an electrocardiogram, an echocardiogram, and usually, cardiac catheterization. Blood tests will be performed to measure formed blood elements, electrolytes, and blood glucose. Additional tests for sickle cell and digoxin levels may be performed, if applicable. For six to eight hours before the surgery, the patient cannot eat or drink anything. Aftercare
After heart surgery for congenital defects, the patient goes to an intensive care unit for continued cardiac monitoring. The patient may also require continued ventilator support. Chest tubes allow blood to be drained from inside the chest as the surgical site heals. Pain medications will be continued, and the patient may remain under general anesthetic. Within 24 hours, the chest tubes and ventilation may be discontinued. Any cardiac drugs used to help the heart perform better will be adjusted appropriate with the patients condition.

For temporary procedures, additional follow-up with the physician will be required to judge timing for complete repair. In the meantime, the patient should continue to grow and thrive normally. Complete repair requires follow-up with the physician initially to judge the adequacy of repair, but thereafter will be infrequent with good prognosis. The child should be made aware of any procedure to be communicated for future medical care in adulthood.

Risks
Depending on the institution and the type of congenital defect repair, many risks can be identified, including shock, congestive heart failure, lack of oxygen or too much carbon dioxide in the blood, irregular heartbeat, stroke, infection, kidney damage, lung blood clot, low blood pressure, hemorrhage, cardiac arrest, and death. These risks should not impede the surgical procedure, as death is certain without surgical treatment. Neurological dysfunction in the postoperative period occurs in as much as 25% of surgical patients. Seizures are expected in 20% of cases, but are usually limited with no long-term effects. Additional risks include blood transfusion reactions and blood-borne pathogens.

Morbidity and mortality rates
Use of cardiopulmonary bypass has associated risks not related to the congenital defect repair. Procedures performed in association with cardiac catheterization have excellent long-term results, with an associated mortality of 2 - 4% of procedures. The Fontan procedure carries a survival rate of over 90%. Surgical procedures to repair coarctation of the aorta, in uncomplicated cases, has a risk of operative mortality from 1 - 2%.

Alternatives
Alternatives are limited for this patient population. Cardiac transplant is an option, but a limited number of organ donors restrict this treatment. Ventricular-assist devices and total artificial heart technology are not yet a suitable option. Temporary procedures do allow additional growth of the patient prior to corrective surgery, allowing them to gain strength and size before treatment.