Pediatric Cardiovascular Surgery

It is possible for children who came to life with heart anomalies and diseases to be brought back to a normal life. At the department of pediatric cardiovascular surgery the diagnosis and the treatment of many diseases are being handled with a multidisciplinary approach.

What Are Pediatric Heart Diseases?

• Atrial Septal Defect (ASD)
• Ventricular Septal Defect (VSD)
• Atrioventricular Septal Defect (AVSD)
• Fallot Tetralogy (Blue baby disease)(TOF)
• Coronary Artery Anomalies
• Patent Ductus Arteriosus (PDA)
• Aorta-Pulmonary window
• Cor Triatriatum
• Coarctation of Aorta (COA)
• Aortic arch Hypoplasia
• Interrupted Aortic Arch (IAA)
• Pulmonery Atresia
• Aortic Valve Stenosis or Regurgitation
• Mitral Valve Stenosis or Regurgitation
• Left ventricular outflow tract obstruction (LVOTO)
• Double Outlet Right Ventricle (DORV)
• Ebstein Anomaly
• Transposition of the Great Arteries (TGA)
• Hypoplastic Left Heart Syndrome (HLHS)
• Triscupid Atresia
• Single Ventricle Physiology Anomalies
• Total Anomalous Pulmonary Venous Return (TAPVR)
• Truncus Arteriosus

What Are Pediatric Heart Surgery Operations?

• ASD closure. With Primary or with patching
• VSD closure. With patching
• Repairing of AVSD. With single or double patching techniques
• Fallot Tetralogy (TOF): VSD closure and elimination of right ventricle/pulmonary stenosis (Full elimination) or Palliative shunt surgeries(Blalock-Taussig or centarl shunt)
• Elimination of right ventricular outflow tract stenosis
• Reconstruction at the stenosis of main pulmonary and branches
• Arterial switch(Jatene), Atrial Switch (Senning or Mustard) at the transposition of Great Veins
• Widening of aortic arch at aortic arch hypoplasia
• Repairing or replacement at aortic and mitral valve diseases
• Ross procedure at Aorta and left ventricular outflow tract stenosis.
• Stem widening surgeries at left ventricular outflow tract stenosis Nick, Konno, Manougian procedures
• Norwood operation at Hypoplastic Left Heart syndrome
• Gelnn/Fontan surgeries at Triscupid atresia-single ventricle treatment
• Double Outlet Right Ventricle(DORV) Rastelli-Inracardiac tunnel
• Repairing of Total or Partial Pulmonary return anomaly 
• Reparing at Pulmonart stenosis or regurgitation or replacement of Pulmonary valve
• Coronary Artery Anomalies(ALCAPA): Takeuchi procedure or reimplantation
• Repairings of Vascular ring, aortic arch anomalies.

Atrial Septal Defect (ASD) (Hole in the heart)

It is the presence of a hole between the right and left atriums. More blood goes to lung. Undernutrition and frequent lung infection can be seen. Unless it is treated at the future ages cardiac insufficiency, increase in the lung blood pressure and arrhythmia can develop. Surgical treatment is generally done at the pre-school period and the hole is closed with small incision.

Ventricular Septal Defect (VSD) (Hole in the heart)

It is the presence of hole between the two ventricles of the heart. More blood goes to lung. Reoccurring lung infection, growth failure, breathing excessively and sweating can be seen. Unless it is treated increase in lung blood pressure and cardiac insufficiency can develop.  Generally surgery is done when the patient is around 6 months old and the hole is closed. Narrowing the lung main artery (pulmonary banding) can be thought as the first option at risky patients without using the heart lung machine (closed-heart surgery).

Atrioventricular Septal Defect (AVSD)

There is a big hole between both the atriums and ventricles. More blood goes to lung. Besides while the valves between both ventricles and atriums must be separate normally at these patients they are connected. There can be insufficiency at the valves. It is more frequently seen at the patients with down syndrome. Excessively breathing, sweating, reoccurring lung infection and growth deficiency can be seen. Unless it is treated permanent lung damage due to increase at blood pressure and cardiac insufficiency can develop. Surgical treatment is done when the patient is around 6 months old and generally the hole is closed with a patching and the valves which are connected are separated. If there is insufficiency at the valves repairing can be planned. Narrowing of the lung artery (pulmonary artery banding) can be preferred firstly at risky patients without using the heart lung machine (closed-heart surgery).

Coronary Artery Anomalies

Coronary arteries are the main arteries that feed the heart. They are generally separated from the body’s main artery (aorta) as two different stems.  While these anomalies have different variations they can show themselves with symptoms like sweating, poor feeding and chest pain. One of the frequently seen forms is the left coronary artery taking origin from lung vein, defined with the acronym ALCAPA.  It can cause cardiac insufficiency and sudden death. It is decided to the surgery technique according to the type of the anomaly.

Patent Ductus Arteriosus

Ductus arteriosus, being a vein between body main artery vein (aorta) and lung main artery vein (pulmonary artery) is needed for circulation at prenatal period. It looses its function after birth and generally it is closed by itself within 72 hours. The state that this vein stays open is called patent ductus arteriosus. It is seen more frequently at the babies that born early (premature). More blood goes to lung. Breathing excessively, growth failure and reoccurring lung infection can be seen. Unless it is treated it can cause increase in lung blood pressure and cardiac insufficiency. At the surgical treatment generally it is entered from the side, between the ribs and after the PDA is found it is closed by binding.

Coarctation of Aorta

It is the stenosis of body’s main artery’s (aorta) right after it leaves heart and gives the branches that feed the head and arms. Because of this narrowness the blood pressure at the upper part of the body is generally lower than that of the lower part.  It can cause sweating, hardship feeding and breathing, reoccurring nosebleed.  Unless it is treated it can cause cardiac insufficiency and high tension. Most commonly used surgical method, is stitching the remaining parts as the narrow area at the vein being taken out by opening the rib cage from the side without using heart lung machine (closed-heart surgery) Using artificial vein (greft) may be required at older kids.

Aortic Valve Stenosis

Aortic valve is between the left ventricle of the heart and main artery vein (aorta) that goes out from there. Generally stenosis develops due to abnormal growth of the calve. In the future period it can reveal itself as chest ache and fainting. Unless treated cardiac insufficiency and sudden death can be seen. At the surgical treatment first option is the repairing of the stenosis. If this is not possible and the size of the patient is fit planting cardiac valve can be planned.

Transposition of the Great Arteries (TGA) (Babies that born with reverse veins)

At this disease lung main vein (pulmonary artery) that needs to be exiting from right ventricle in a way that it will exit from the left ventricle, main vein (aorta) that needs to be exiting from right ventricle in a way that it will exit from the left ventricle, they changed places. Arterial blood needs to be going to the body is sent to the lung, venous blood that needs to be going to the lung is sent to the body. Therefore after birth cyanosis can be seen.  Surgical treatment is generally done at the patient’s neonatal period and the veins that come up as reversed are transferred to the places that they should be at (jatene surgery). At the patients that are late procedure of translocation of atriums (senning surgery) can be planned.

Fallot Tetralogy (Blue baby disease)

It is the most commonly seen disease among the congenital heart diseases that causes cyanosis. It has 4 constituents; hole between ventricles, body’s main artery vein (aorta) overriding (slipped right), right ventricle outflow tract stenosis and right ventricle muscle thickening.   Less blood goes to lung. Generally cyanosis increases with crying and effort.   Empurpling seizures, fainting and sudden death can be seen. Surgical treatment is done when the patient is at 6 months of age and the hole is closed with patching, outflow tract and muscle thickening at the right ventricle is eliminated.  At this period it is aimed to protect the heart valve (pulmonary valve) that is located between the right ventricle and lung artery as much as possible and repair if necessary. At the risky patients making a connection between body artery and lung artery with artificial vein (shunt surgery) without using heart lung machine (closed-heart surgery) can be preferred firstly.

Hypoplastic Left Heart Syndrome (HLHS) (Half hearted babies)

It is a disease at which there is a serious growth failure at the atrium that makes the left side of the heart, at the ventricle, at the valves (mitral and aorta) and at body’s main artery (aorta). At this disease surgical treatment with 3 steps is generally applied. The first step is done when the patient is at neonatal period and it is a complex procedure that will allow the right atrium to pump blood both to body and with artificial vein (greft) to lung (norwood surgery). The second step is done when the patient is at 6 months of age and the venous blood that comes from the upper part of the body is connected to the lung artery (glenn surgery). The third step is done at around the range of 2-5 ages after the patient has started to walk and the venous blood that comes from the lower part of the body is connected to the lung artery with artificial vein (fontan surgery). At risky patients the process of narrowing both two lung arteries (bilateral pulmonary artery banding) and applying stent to the ductus vein without using heart lung machine (closed-heart surgery) which is called hybrid growth can be planned.

Interrupted Aortic Arch (IAA)

It is the interruption of body’s main artery (aorta) at the part after it leaves the heart where it stems the head and arm veins.  Unless the blood flow that goes to the lower part of the body is maintained because of the interruption there is risk of serious circulatory disorder and death. There is generally a hole between ventricles. Surgical treatment is generally done when the patient is at neonatal period and the interrupted vein part being taken out the remaining parts are stitched end to end (patching may be required), if there is a hole at the heart it is closed.

Single Ventricle Physiology Anomalies

At this disease a ventricle takes on the pumping mission of the heart instead of two ventricles.  Additional anomalies frequently accompany. At this disease surgical treatment with 3 steps is generally applied. The first step is generally done when the patient is around 0-3 months of age; if the lung blood flow is much the lung main artery is narrowed (pulmonary artery banding), if the lung blood flow is less artificial vein is placed between body artery and lung artery (shunt surgery). The second step is done when the patient is at 6 months of age and the venous blood that comes from the upper part of the body is connected to the lung artery (glenn surgery). The third step is done at around the range of 2-5 ages after the patient has started to walk and the venous blood that comes from the lower part of the body is connected to the lung artery with artificial vein (fontan surgery).

Total Anomalous Pulmonary Venous Return (TAPVR)

Arterial blood that normally comes from the lung with the help of lung vena goes to left atrium and is pumped to the body via left ventricle.  At this anomaly lung vena has no direct connection with left atrium. This connection is obtained indirectly via a hole present between two atriums of the heart.  It can cause symptoms like breathing excessively, reoccurring lung infection and nutritional deficiency.  Unless it is treated it can cause increase in lung blood pressure, cardiac insufficiency and death. Surgical treatment generally is done when the patient is at neonatal period; lung vane is connected to the left atrium and the hole in the heart is closed.

Truncus Arteriosus

Normally body and lung main arteries exit the heart separately, but at this disease these two main veins exit as one stem and then separate from each other. More blood goes to lung. Almost always there is a hole present between ventricles. Unless it is intervened at the early stage increase at lung blood pressure, permanent lung damage and cardiac insufficiency can develop. Surgery is generally done when the patient is at neonatal period.  At the surgery the lung connection of the vein that exits the heart as one is cut and it is procured that it only feeds the body, and the feeding of the lung is procured by the artificial vein that is put between the right ventricle and lung main artery.  Hole in the heart is closed.