Most advanced technology and equipment for the best outcome in a pediatric cardiac surgery in india

Most Advanced Technology and Equipment for the Best
Outcome in a Pediatric Cardiac Surgery in India
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Pediatric Cardiac Surgery at world Class
Hospitals in India
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A successful cardiac surgery in children requires an expert
medical team - doctors, nurses, and other support staff - who
are experienced in such surgeries, can promptly recognize
problems and emerging side effects, and know how to react
swiftly and properly if problems do arise. A cardiac surgery
program will also recognize the importance of providing
patients and their families with emotional and psychological
support before, during and after the surgery, and will make
personal and other support systems readily available to
families for this purpose. We make this difficult journey easy
for the patient and his relatives.
Paediatric surgeries deal with the correction of abnormalities
present in the heart of new-borns, infants or children. Most of
the defects are present since birth (congenital). They all come
under the category of congenital heart defects. Some are
present since birth but cause symptoms after a few years and
some cause symptoms immediately after birth.

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Pediatric cardiac surgery or paediatric heart surgery deals with
the heart problem of new borns, infants and children.
Paediatric heart problems are usually present at birth i.e. are
mostly congenital.
The most common heart ailments in children
are:
oAtrial Septal Defect
oVentricular Septal Defect
oFallot's Tetralogy
oValvular defects
Paediatric heart surgery is quite different and complex than cardiac surgery in adults. The
physiology and disease process in children is different from adults. Surgeries on heart and lungs
among children are the most intricate of all surgeries done on the human body. This is so
particularly because of small size, tissue immaturity, high energy and metabolic requirement and
immunity.
The surgery thus requires special set up and specially trained surgeons to perform the heart
surgery. Paediatric cardiac surgeons are specially trained surgeons to treat the heart problems in
children.
Major Types of Cardiac Defects in Children

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ASD- Atrial Septal Defect
ASD- Atrial Septal Defect refers to a hole in the septum that separates
the right and left atrium. This results in mixing of pure and impure
blood. Depending on the size of the defect, the symptoms may range
from no symptoms to bluish discoloration of the body, increase
pulmonary blood pressure and irregular cardiac contractions
(arrhythmias). It is corrected by open heart surgery. The sternum is
split in the midline. Arterial and double venous (superior vena cava and
inferior vena cava) vessels are clamped. By applying cardiopulmonary
bypass (heart lung machine), the aorta is clamped, and the heart is
temporarily paralyzed by a solution. The right atrium is opened and the
defect is sutured.

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Ventricular Septal Defect
Ventricular Septal Defect - is a hole in the wall between the right and left ventricles
of the heart. This abnormality usually develops before birth and is found most often
in infants. A ventricular septal defect can allow newly oxygenated blood to flow from
the left ventricle, where the pressures are higher, to the right ventricle, where the
pressures are lower, and mix with un-oxygenated blood. The mixed blood in the
right ventricle flows back or recirculates into the lungs. This means that the right and
left ventricles are working harder, pumping a greater volume of blood than they
normally would. Eventually, the left ventricle can work so hard that it starts to fail. It
can no longer pump blood as well as it did. Blood returning to the heart from the
blood vessels backs up into the lungs, causing pulmonary congestion, and further
backup into the body, causing weight gain and fluid retention. If the VSD is large and
surgically uncorrected, pressure can build excessively in the lungs, resulting in
pulmonary hypertension. The higher the pulmonary pressure, greater the chances of
blood flowing from the right ventricle to the left ventricle, backwards, causing un-
oxygenated blood to be pumped to the body resulting in cyanosis (blue skin). The
risk for these problems depends on the size of the hole in the septum and how well
the infant's lungs function

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Fallot's Tetralogy
It is the most common congenital heart defect in children.
The defect results in mixing of pure and impure blood.
It comprises a combination of four defects- right ventricular
hypertrophy (increase in the size of right lower chamber),
ventricular septal defect (whole in the wall between the two
ventricles), abnormal position of aorta (aorta is on right side
of heart instead of the left) and pulmonary stenosis
(narrowing of pulmonary valve opening which prevents
outflow of blood from right ventricle).
Two major surgeries help to correct these abnormalities.
•Blalock- Taussig's operation is a palliative procedure performed in smaller infants to
increase blood flow to lungs and to allow the child to grow big enough to withstand the corrective
surgery. A connection is made between right subclavian artery and pulmonary artery to pass
more oxygenated blood to the latter. This relieves the cyanosis to a great extent.
•The total corrective surgery is performed in children within 2 years of age. VSD is closed
with a patch and the narrowed pulmonary valve is opened. The outcome of surgery is favourable
and most children lead a healthy life after the surgery with minimum restrictions.

Double valve repair and replacement
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Valves are openings between two chambers and also between a chamber and artery which
allows unidirectional flow of blood. The patency of these valves is very important for normal
flow of blood. The function of mitral valve (between left atrium and left ventricle) and the
aortic valve (between left ventricle and aorta) is very important. If these valves get narrowed,
the amount of blood passing from left atrium to left ventricle (mitral valve) or from left
ventricle to aorta (aortic valve) is drastically reduced. In this case the heart will pump blood
harder to push it through the narrowed valves. But the blood will tend to go upwards back
into the pulmonary vein and finally to the lungs. This will cause excess blood in the lungs
leading to congestion. At the same time very less blood will come out into the aorta from the
left ventricle which will result in reduced blood and oxygen supply to all the body parts.
Double valve repair and replacement procedure aims at correcting or replacing these both
these damaged valves (aortic & mitral together) with new functional valves. This is done
through the open heart surgery. The patient is put under general anaesthesia and connected
to the heart lung machine. This machine takes over the pumping, circulatory, and respiratory
functions of the heart and lung till the surgical procedure is going on. The valves are accessed
by cutting open the rib cage and accessing the heart directly. The old valves are sliced from
their attachments and new valves are put in their place. The new valves may be obtained from
a cadaveric donor, or an animal (pig) or it may be made of a nonreactive inert material.

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Most advanced technology and equipment for the best outcome in a pediatric cardiac surgery in india