Procedures & Surgeries

Surgical closure of PDA is done less frequently these days. Usually this becomes necessary in very large hypertensive ducts in early infancy when suitable catheter procedures are not possible. This is done through the left side of the chest under general anesthesia.

This is a surgery to reduce the blood flow to the lungs. This surgery should ideally be done before 6 weeks of age. This procedure is done as a preliminary step to other destination surgeries like a Fontan operation. Although the surgery is technically simple it has vast physiological implications that makes this operation very critical.

This is a procedure to increase the blood flow to the lung using an artificial tube to connect the aorta (carrying blood to the body) and the pulmonary artery (carrying blood to the lungs). It is usually done in infancy in conditions of pulmonary obstruction. This operation may be done through the midline cutting the sternum or from the side of the chest entering between the ribs. This is a temporary procedure and the shunt created is taken out, when the next permanent operation is carried out.

This is usually an emergency and the child is invariably in heart failure. Here the main artery carrying blood from the aorta gets narrowed at a particular point such that the flow of blood is obstructed causing the heart to be under strain and the lower part of the body has not enough blood flow resulting in poor functioning of end organs like the kidney. This is corrected by cutting away the narrowed area and reconstructing the aorta.

The large artery carrying blood from the heart to the body the 'aorta' has a narrowing at a specific location that causes an obstruction to the flow of blood to the rest of the body. This a condition by birth to which the patient adapts by forming many collateral pathways. But this often insufficient to dispersed the blood pressure, and results in very high blood pressure in the upper limbs, predisposing the patient to the dangers of high BP like a bleed in the brain. This becomes even more risk prone in pregnancy. It could result in heart failure sometimes very acutely called as 'pulmonary edema'. In adults this is usually corrected by 'jumping' over the diseased segment with an artificial tube. Its called as a ' jump graft'.

This is a defect by birth where there is a hole in the heart between the lower chambers (pumping chambers) of the heart. In addition the passage of blood to the lungs is obstructed partially resulting in a mixing of pure and impure blood. Severe cases of this condition result in very blue babies.

Usually this is corrected by surgery in the first or second year of life. Sometimes this condition may have to be palliated with a BT SHUNT in early infancy if the pulmonary arteries are not developing well.

Once corrected this leads to normal life style. But the child has to be followed up carefully over the years to monitor the right ventricular function.

Ventricular Septal Defect (VSD) is a hole in the heart between the lower chambers (pumping chambers) of the heart. This is a defect by birth and needs to be closed, the timing depends on the size and location of the hole, larger ones causing heart failure in infancy need to closed as early as at 3 months of age and is done surgically using a patch of Teflon or treated pericardium. This procedure can be complicated by the development of a heart block if the VSD margin is part of the inflow to the right ventricle, as this brings the electric wiring of the heart in close proximity to the area of surgery.

This is a defect by birth where there is a hole in the heart between the lower chambers (pumping chambers) of the heart. In addition the passage of blood to the lungs for oxygenation is obstructed completely resulting in a mixing of pure and impure blood, resulting in very blue babies.

Often this condition has to be palliated with a BT SHUNT in the first month of life itself and subsequent surgeries are required to obtain complete correction of this problem.

Once corrected this leads to normal life style. But the child has to be followed up carefully over the years to monitor the right ventricular function.

Sometimes the defect is more complex, with the passage to the lung being completely undeveloped and blood reaches the lung for oxygenation through alternate channels called Major Aorto Pulmonary Collateral Artery (MAPCA), since these channels come in a haphazard manner they need to be surgically connected together by a procedure called unifocalization and then connected to the right ventricle of the heart by a tube to recreate the pulmonary artery. For this the part taken and preserved from the heart of a heart donor called as homograft is used.

Ventricular Septal Defect (VSD) is a hole in the heart between the lower chambers (pumping chambers) of the heart. This is a defect by birth and needs to be closed surgically. Often there may be more than one hole ( multiple VSD or Swiss Cheese VSD), or the hole between the pumping chambers may be part of more complex defects where the valves between the upper collection chambers of the heart and the lower pumping chambers of the heart may also be abnormal, resulting in conditions like AV CANAL DEFECT, OR SINGLE VENTRILE with non development of either one of these valves called as TRICUSPID ATRESIA or MITRAL ATRESIA

Transposition of the Great Arteries (TGA) a complex anomaly of the heart where the great arteries of the heart, the one going to the lungs (carrying impure blood) and the one going to the body (carrying pure blood) are interchanged, such that impure blood returning to the body returns to the body and pure blood returns to the lung. Survival after birth is possible only if the blood mixes at some level like the ASD, VSD or PDA.

This condition is corrected in the first month of life by this surgery which involves relocating the great arteries to their respective ventricles and transferring the coronary artery origins also to the new aorta.

This a technically demanding operation.

Is a surgery done to correct a complex anomaly called Corrected Transposition of the Great Arteries (cTGA), where the ventricles are interchanged by birth, so the surgery done ensures that the ventricle pumping pure blood to the body is the stronger ventricle as in the normal heart.

The surgical solution for improving blood flow to the lungs for oxygenation by connecting the superior vena cava directly to the pulmonary artery. This is the first half of a complex operation for the palliation of a complex congenital heart anomaly called single ventricle. These children have only one pumping chamber instead of two, and invariably the flow of blood to the lungs is also obstructed. This operation may be preceded by a BT Shunt operation if needed in the first one or two months of life. This operation is ideally carried out after the 9th month of life when the child is able to sit upright.

More complex defect, with the passage to the lung being completely undeveloped and blood reaches the lung for oxygenation through alternate channels called Major Aorto Pulmonary Collateral Artery (MAPCA), since these channels come in a haphazard manner they need to be surgically connected together by a procedure called unifocalization and then connected to the right ventricle of the heart by a tube to recreate the pulmonary artery. For this, the part taken and preserved from the heart of a heart donor called as homograft is used.

Open heart surgery is any surgery done on the heart using the heart lung machine, where all the blood returning to the heart is diverted to the machine where it is oxygenated and returned to the body. Thus the heart can be isolated from the circulation and stopped and opened to facilitate operations within the heart like closing a hole, repairing or replacing a valve or removing a tumor.

Redo operation means that the patient had an heart operation earlier and needs a subsequent surgical procedure on the heart, like re repair of a valve, coronary bypass surgery. These surgeries are different from a first time surgery in that the structure like the covering of the heart are adherent to the heart making surgery more technically demanding. These surgeries may be done by the same approach as in the first instance or through an alternate route like a through the side of the chest.

Patent ductus arteriosus (PDA) is an abnormal connection between the great arteries of the heart namely, the aorta (taking pure blood to the body) and the pulmonary artery (taking impure blood to the lungs). This usually done through a small cosmetic incision on the side of the chest. Most of the PDA can be closed by catheter procedure. However some very large ducts and some infected or aneurysmal (much dilated) ducts can be closed by surgery only. PDA should be closed one way or the other once diagnosed.

Usually done in children because the leads have to be placed on the surface of the heart (epicardium) and also the pocket for the pulse generator has to be created under the muscle in the wall of the abdomen and sometimes inside the chest in very small infants. It is often needed when there is a complete heart block, that is the patients heart beats abnormally at a very low rate because of a fault in the conduction electrical impulse.

When part of the heart like the pulmonary trunk (passage to the lungs) is missing or has to be reconstructed when it is used to correct defects of the aortic root (passage to the body), homografts are used. These are parts of the pulmonary or aortic passages including the respective valve and the great artery, harvested from hearts donated for this purpose by the dead. These parts are sterilized and processed, and then cryopreserved so that they can be used as when the need arises. Homografts are non vital and will degenerate with time necessitating revision surgeries to replace them.

In some of the defects by birth both the great vessels to the lung and the body arise from the right ventricle, pumping chamber that normally pumps blood to the lungs only. In such cases it becomes necessary to reconstruct the passage the lung separately using a homograft after routing the blood from the left ventricle to the aorta through the VSD by creating an intraventricular tunnel.

In this congenital defect, instead of two great arteries there is only one great artery the truncal artery arising from both ventricles together. In place of separate pulmonary and aortic valves there is a common valve called the truncal valve, this may be competent or incompetent (leaking) and need repair and future replacement. The pulmonary (lung) arteries arise from the truncal artery. There usually will be a large VSD. Correction involves closing the VSD, separating the pulmonary artery from the aorta and reconstructing the right ventricle to the pulmonary artery passage using a homograft or directly.

This usually occurs in the setting of Tetralogy of Fallot. Here the right ventricle (chamber pumping blood to the lungs is smaller in size, and if the VSD is closed, the right ventricle will be too small to handle the entire cardiac output. Therefore the repair of this condition incorporates a B D Glenn shunt diverting some of the blood directly to the lungs, so that the ventricle is partially off loaded and capable of handling all the blood that reaches it.

Heart valves are leaf like structures situated between the various chambers of the heart and open in a one direction only. This ensures that blood does not return to the chamber from which it was pumped forward. Abnormalities like Mitral Regurgitation (MR) (a valvular heart disease which results in the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart), or Aortic Stenosis (a condition where the aortic valve becomes narrower than normal, impeding the flow of blood out of the left ventricle) are corrected surgically by repair of the native valves, this may involve opening a valve or reducing the valve orifice and shortening a flail leaflet to achieve competence of the valve. Sometimes artificial chords have to be made. Here the valve is not replaced but it is repaired using these techniques. Thus the native valve is retained. This is an excellent approach to the problem, because it AVOIDS all the complexities of valve replacement like excessive bleeding or of clot embolization leading to paralytic stroke.

Only draw back is that with time the valve may give trouble again and a second surgery may be needed

Heart valves are leaf like structures situated between the various chambers of the heart and open in a one direction only. This ensures that blood does not return to the chamber from which it was pumped forward. Abnormalities like Mitral Regurgitation (MR) (a valvular heart disease which results in the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart), or Aortic Stenosis (a condition where the aortic valve becomes narrower than normal, impeding the flow of blood out of the left ventricle) are corrected surgically by excising the diseased valve stitching in an artificial heart valve. This is an open heart surgery.

More than one heart valve is replaced. Usually the mitral and aortic valves are replaced together.

Heart valves are leaf like structures situated between the various chambers of the heart and open in a one direction only. This ensures that blood does not return to the chamber from which it was pumped forward. Abnormalities like Mitral Regurgitation (MR) (a valvular heart disease which results in the abnormal leaking of blood through the mitral valve, from the left ventricle into the left atrium of the heart), or Aortic Stenosis (a condition where the aortic valve becomes narrower than normal, impeding the flow of blood out of the left ventricle) are corrected surgically by excising the diseased valve stitching in an artificial heart valve. This is an open heart surgery.

A form of heart surgery that redirects blood around clogged arteries to increase blood flow and oxygen to the heart. This offers patients faster post-operative recovery with fewer complications. The conduits used to bring blood and create new channels for blood to flow to the heart musculature, are the internal mammary artery which is found inside the chest wall, the radial artery which is the artery of the fore arm and the saphenous vein which is seen in the leg.