Pediatric Cardiac Surgery at the Apollo Hospitals Hyderabad
Pediatric Cardiac Conditions : -
Congenital Heart Diseases (BIRTH DEFECTS OF HEART)
Types of Congenital Heart Diseases & Surgeries : -
- INCIDENCE : - At least 8 of every 1000 infants born have some form of heart defect. In India, approximately 1-1.5 lak children are born with some form of heart defect every year. The symptoms vary from mild with a apparently normal child to very severe becoming sick soon after birth. Some of the common pediatric cardiac problems have been listed below to provide a basic introduction to the problems and their treatment
VENTRICULAR SEPTALE DEFECT (VSD) : -
VSD is a hole in the heart between the left and right ventricles (lower chambers). This is the most common heart defect in children. These holes can vary in their size. Babies with large holes develop heart failure, increase in lung pressure, and quite often not grow well.
These large holes need early surgery and can be closed with very little risk. Babies with small holes close on their own and rarely require surgery. Location of holes, their size and number determine whether they close spontaneously or require surgery.
PATENT DUCTUS ARTERIOSUS (PDA) : -
A PDA is an abnormal opening communication (tube) between the aorta and the pulmonary artery. This opening causes too much blood flow to the lungs, and gets the lungs all wet.
Kids with a PDA can get winded pretty quickly, and babies with a large PDA may not grow normally. A PDA can be easily ligated by a heart surgeon. Small PDA's can be closed with a catheter using special devices.
ATRIAL SEPTAL DEFECT (ASD) : -
ASD is a hole in the heart, located between the left and right atria (upper chambers). This type of "hole in the heart" can be readily closed by a special device that is placed to plug up the hole or can be closed by a heart surgeon.
Not all ASD's are suitable for device closure and such cases can be closed surgically. Surgery for ASD's can be performed through a right posterior thoracotomy approach (back of the chest for girls), which gives a cosmetically appearing scar compared to midline sternotomy scar.
TETRALOGY OF FALLOT (TOF) : -
There are four major defects in TOF. The two defects of importance are the VSD and the narrowing in the pulmonary artery (pulmonay stenosis). The other two are hypertrophy of the right ventricle and over riding of the Aorta.
This condition requires surgical repair to fix these abnormalities and is recommonded at 3-4 months of life. In exceptionalcases, a severly blue child or a very scik child , a minor surgery called BT shunt is performed.
TRANSPOSITION OF THE GREAT ARTERIES (TGA) : -
In TGA, the two great vessels swap their positions with the heart chambers (ventricles), such that the aorta is where the pulmonary artery should be, and the pulmonary artery is where the aorta is.
TGV is repaired by "switching" the position of the two great vessels, thereby bringing them to normal position with the chambers and is performed soon after the diagnosis without much waiting.
COARCTATION OF THE AORTA (COA) : -
A coarctation is an abnormal narrowing in the main blood vessel of the body, called the aorta. A coarctation can be readily repaired by a surgeon and can be opened with a balloon catheter by a Cardiologist without surgery.
Certain types of narrowing of Aorta can be better managed by surgery alone.
TRUNCUS (TRU) : -
In truncus, the pulmonary arteries come off the aorta instead of the right ventricle. In addition, there's also a large hole in the heart, called a VSD.
Truncus is repaired by dividing the pulmonary artery off the aorta and connecting it to the right ventricle with a valve conduit. The VSD is also closed to get the circulation back to normal.
AORTIC STENOSIS (AS) : -
Stenosis means narrowing and aortic stenosis is narrowing of the aortic valve or narrowing of the aorta directly above (supravalvar) or below (subvalvar) the aortic valve.
Depending on the severity of the stenosis, surgery is needed to correct the defect. Another option may be a balloon valvuloplasty if the narrowing involves valve alone. This procedure is done by the cardiologist.
PULMONARY STENOSIS (PS) : -
PS is a narrowing of the pulmonary valve. Normally the pulmonary valve opens to let the blood flow from the right ventricle to the lungs where the blood gets oxygenated. Because of the narrowing the right ventricle has to work harder to get past the stenotic valve.
This can sometimes lead to enlargement of the right ventricle. Depending on the severity of the pulmonary stenosis, open heart surgery may be indicated to correct the defect. Another option is balloon valvuloplasty. This procedure is done in the cardiac catheterization lab.
TOTAL ANOMALOUS PULMONARY VENOUS RETURN (TAPVR) : -
Pulmonary veins normally bring oxygenated blood back from the lungs to the left atrium. In total anomalous pulmonary venous connection all the pulmonary veins drain into the right atrium. Open heart surgery is needed in early infancy.
Early open heart surgery is needed for this condition.
ATRIO VENTRICULAR SEPTAL DEFECT (AVSD) : -
In this condition, there are holes in the upper and lower chambers (ASD and VSD) along with common atrio ventricular valve (instead of two valves - Tricuspid and Mitral).
Early surgery is the treatment of choice, where in the surgeon closes both the holes and reconstruct the common valve into two valves (Tricuspid and Mitral).
Detecting Congenital Heart Diseases : -
The Pediatric Cardiologists at the Heart Institute in Apollo Health City use various diagnostic procedures to determine the heart diseases in children. The congenital heart defects can be diagnosed even when the child is in the mother's womb through Fetal Echocardiography.
The following diagnostics are generally carried out : -
- ECHO-The pediatric cardiologist performs the echo to determine the heart disease.
- Chest X Ray
- TEE Transesophageal Echocardiogra
- PET CT - In most scenarios the consultants use the help of PET CT which gives accurate results. Apollo Health City has the PET and 16
slice, please browse the site to know more about the Apollo Gleneagles PET CT Centre
- Lab Investigations
Interventional Procedures : -
- Cardiac Catheterization
- Balloon Valvotomy
- PDA Device closures
- Patent Foramen Ovale Closures
CORONARY ARTERY DISEASE (CAD) : -
Coronary Artery Disease or CAD is one of the major killers in India. In recent times CAD is effecting the youth as well. Busy lifestyles, stress, habits like oking,alcohol, and fatty foods are leading to CAD in youth.
Heart Attacks (Myocardial infraction) are a manifestation of CAD's. Blockage or narrowing of coronary arteries leads to CAD's. The arteries supply blood to theheart; blockages caused in arteries like cholesterol, narrowing, atherosclerosis restrict blood flow to the heart. The heart starves for oxygen and nutrient rich blood causing an infraction or heart attack. Ischemia is a condition where the heart muscle gets cramped due to lack of blood.
Acute coronary syndrome is 3 types : -
- Angina - Poor blood supply to the heart for a small period is called angina. It can last over a period of time and can be treated with oral medications. Patient having known CAD carry their oral medications all the time.
- Non-ST segment elevation myocardial infarction (NSTEMI) - In such infractions the ECG does not record any changes. In such scenarios chemical markers are used to diagnose it
- ST segment elevation myocardial infarction (STEMI) - Blockage in the supply of blood for a long period affect the heart muscle to a large extent. ECG and chemical markers show immediate changes.
Symptoms : -
- Shortness of breath
- Chest pain
- Excessive sweating
- Pain from the chest to the arms
Diagnosis : -
- Stress Test
- Chest X Ray
- Ultra sound
- Blood Investigations
- Advanced diagnostics involves Catheterization and Angiogram
Treatment : -
- Lifestyle Modifications : Patients diagnosed in initial stages of CHD are recommended to make life style modifications like quit smoking, reduce alcohol consumption, exercise, food modifications, monitoring blood pressure and diabetes and medications are prescribed by your cardiologist accordingly
Interventional procedures are mostly used to open up blockages in the arteries. There are 3 types of interventional procedures
- PTCA (Percutaneous Transluminal Coronary Angioplasty) or Balloon Angioplasty : This procedure involves placing of a small balloon at the tip of the catheter and inserting it in to the blocked artery. Once the balloon reached the blocked are it is inflated leading to dilation of the area.
- Stent : A stent is a small metal tube that is inserted in to the blocked artery through the balloon. The metal tube restricts the blockage.
- Rotablation (Percutaneous Transluminal Rotational Atherectomy or PTRA): A diamond tip catheter is inserted in to the blocked artery. It is then rotated at high speed to clear the blockage.
Coronary Artery Bypass Graft (CABG) Surgery : -
CABG surgery involves bypassing the blocked coronary arteries with a blood vessel graft. These grafts are usually taken from patient's own arteries and veins located in the chest (thoracic), leg (saphenous) or arm (radial). The graft goes around the blocked artery (or arteries) to create new pathways for oxygen-rich blood to flow to the heart.
On Pump (Heart Lung Machine) Heart Surgery
Traditional CABG is performed on still heart i.e the circulatory system is entirely taken over by the heart lung machine that performs the functions of the heart and lungs during the surgery and the surgery is performed on the heart.
Off Pump (Heart Lung Machine) heart surgery : -
A highly advanced procedure in which the heart is kept in a controlled environment using advanced operating equipment and the surgery is performed while the heart is beating. The aim of off pump is to minimize the risk of other complications like renal failure, stroke and reduce the need of blood transfusion.
The decision to go for an off pump or on pump surgery completely lies with your surgeon. It is only decided on the operation table once they evaluate your circulatory system more closely. Both on pump and off pump heart surgeries have had similar results at the heart institute at Apollo Health City.
After Surgery : -
The patient after surgery is moved in the intensive care unit where he/she is thoroughly monitored. The surgeon decides when you are fit to leave the ICU and move to step down. In step down along with monitoring and medication the patient is put through a rehab program.
Branches of Apollo Hospitals in India : -
||Apollo Hospital, Chennai, India
||Apollo Specialty Hospital, Chennai, India
||Apollo Hospitals, Bangalore, India
||Apollo Hospitals, Ahmadabad, India
||Apollo Hospitals, Hyderabad, India
||Apollo Gleneagles Hospital, Kolkata, India
||Apollo Victor Hospitals, Goa, India
||Indraprastha Apollo Hospital, Delhi, India
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