Heart Defect Repair

Any surgery, including heart surgery, comes with some risks, such as:

• Infection. Anytime the body is opened up, infections can get into it. Surgeons are very careful about keeping things sterile and clean during surgery, but there is always a chance of infection.
• Pain. There will likely be some soreness and pain after surgery.
• Bleeding and blood clots. Sometimes the incisions (cuts) in the body continue to bleed, which can make recovery take longer. Sometimes the body forms a blood clot where the surgery was done, and the clot blocks an important blood vessel to the lungs, heart, or brain. This can cause a stroke or damage to other parts of the body.
• Reaction to anesthesia [an-uhs-THEE-zhuh]. Some people don’t react well to anesthesia and may have nausea and vomiting.
• Damage to the heart muscle. Though rare, the heart could be damaged during surgery.
• Problems with replacement valves. Valves can wear out or, if mechanical, have blood clots form on them.
• Death. Death from open-heart surgery is possible but extremely rare.

Heart defect repair helps the blood flow throughout the body correctly. It helps the body get the blood and oxygen it needs. In some cases, it is a life-saving surgery. In others, it can dramatically improve the quality of life by fixing problems like weakness, dizziness, and shortness of breath.

Preparation for surgery depends on the type of surgery you have. The doctor or nurse will tell you how to prepare for your surgery. Most likely, you will have instructions about not eating or drinking before the surgery. The doctor may also tell you to stop taking some of your medicines or vitamins before surgery. Follow all of the instructions you get for preparing for surgery.

Make a plan for the day of surgery and afterward, including:

• Determining who will drive. If the surgery is for you, have a plan for who will take you to the surgery and who will take you home.
• Determining who will help you. The week after you get home is the most important time after surgery. Parents of babies and children having heart surgery should also ask for help from friends and family. They can help out at home while your child is in the hospital. Have plenty of food available or have a plan for someone to bring in meals.
• Understanding the directions the hospital gave you about how to take care of yourself or your child after surgery. Take any medicines (or give them to your child) exactly as the doctor describes.
• Preparing for any changes to your living space. For example, make that you will be able to access your bedroom and bathroom without much trouble.

Surgery done by cutting can be either open-heart surgery or minimally invasive surgery.

• Open-heart surgery. Most heart defects are repaired with open-heart surgery. The surgeon opens up the chest and repairs the defect using stitches, tubes, or patches, depending on the best solution. You will have anesthesia to put you in a deep sleep so you don’t feel any pain. The heart must be stopped from beating during the surgery so the surgeon can do the repair. While the heart is stopped, a heart-lung bypass machine makes sure that you get oxygen and your blood moves through in your body. This surgery requires a hospital stay. After surgery, you may go to the intensive care unit (ICU) before you are moved to a regular hospital room.
• Minimally invasive repair with a catheter. With this procedure, the surgeon puts a catheter (thin tube) through an artery in the groin and up to the heart. The surgeon uses imaging, such as x-rays, to see where to place a patch, clip, or another type of repair. This procedure may be done in a hospital, laboratory, or outpatient surgery center.

The doctor will tell you the results of the surgery once the surgery is completed and you are able to talk.

After surgery:

• You may have some follow-up treatment. This may include additional surgeries for complex heart defects.
• Your doctor may recommend outpatient cardiac rehab. This program focuses on exercise, education, and support to help build a stronger heart. Research has shown that people who attend cardiac rehab have better outcomes after heart surgery. Most adult heart surgery patients attend outpatient cardiac rehab a few times a week for several months.
• You and your doctor will talk about a treatment plan. You will both discuss different treatment options.

You or your child’s recovery will depend on the type of surgery performed, other health problems, and other factors.

For recovery from open-heart surgery:

• It may be one to two months before you feel better. This recovery time is generally true for children as well.
• You may not have much appetite at first, and you may have some trouble sleeping.
• You may have some pain as the incision and sternum (breastbone) heal.
• You may need a laxative for constipation.
• Don’t push, pull, or lift anything with your arms. This could make your sternum separate and slow down healing. Pushing, pulling, or lifting could also open the incision and cause an infection.
• Don’t pull or lift a child who has had open-heart surgery by the arms or armpits. Tell your child not to lift their arms above the head.
• Be careful getting into and out of bed. See “Protecting Your Sternum After Heart Surgery” to learn the right way to get into and out of bed.
• Take care of the incision exactly as the doctor or nurse tells you at the hospital. Call the doctor if you start to have a fever, or if you notice redness, swelling, pus, or increasing pain near the cut.
• Follow the doctor’s instructions about when you (or your child) can get back to regular activities and exercise. You may have to wait for about 6 weeks before you can drive.
• Try to soothe your infant so the infant doesn’t cry for too long during the first month after surgery.
• Both children and adults are not quite themselves after surgery. Adults may feel down and irritable. Children may cry and be fussy. Your child may want you near all the time. Potty-trained children may wet the bed. Support children as they heal, and gradually get back to the limits and behaviors that were in place before surgery.

For recovery from a catheter procedure:

• Expect some discomfort for a few days where the incision was made.
• Take your medicines exactly as your doctor ordered to manage your pain and prevent infection.
• You may need a laxative for constipation.
• You will have a bandage on your groin for about four days. You will need to keep this clean and dry.
• You may not take a bath or go swimming until your doctor says it’s okay.
• You may not lift anything that weighs more than a gallon of milk for several days.
• You may not do any activities that include bending or squatting for at least one week.
• You may do light exercise, such as walking, but no running, for at least one week.

• "Heart Valve Surgery: Preparing for Surgery"
• "PFO and ASD Closure in the Cath Lab"
• "Patent Ductus Arteriosis (PDA) Repair"
• "Mitral Clip Procedure"
• The Society of Thoracic Surgeons, "What to Expect After Heart Surgery"
• Medline Plus, "Pediatric Heart Surgery - Discharge"

Heart defect repair is surgery to fix congenital [kuhn-JEN-i-tl] heart disease — a problem with the structure of the heart that is present at birth. It is the most common birth defect, affecting about 8 out of every 1,000 newborn babies. The cause is usually unknown. The heart has many parts, so there are many different possible defects, such as:

• Patent ductus arteriosus [ahr-TEER-ee-OH-sus] (PDA). This heart defect is a hole in the artery that connects the aorta (the artery that carries blood and oxygen to the body) and the pulmonary artery (the artery that takes blood from the heart to the lungs for oxygen).
• Coarctation [koh-ahrk-TEY-shun] of the aorta. In this condition, part of the aorta is too narrow.
• Atrial septal defect (ASD) and patent foramen ovule (PVO). This heart defect is a hole in the wall that separates the upper chambers of the heart.
• Ventricular [ven-TRIK-yuh-ler] septal defect (VSD). This defect is a hole in the wall that separates the lower chambers of the heart.
• Transposition of the great vessels. In this condition, the aorta and pulmonary artery grow out of the opposite side of the heart from where they should be.
• Valve problems. A flap between an upper and lower chamber of the heart is missing or damaged.
• Hypoplastic [hahy-poh-PLAS-tik] left heart. Severe defect in which the left side of the heart did not grow and develop.

Not all heart defects require surgery. However, a severe congenital heart defect must be found and repaired as early as possible to prevent future health problems.