Closed Heart Surgery Treatment Cost in India

Usually infants and children require closed heart surgeries if they have the following defects:

• Patent ductus arteriosus: Fetus has blood vessels running between the aorta and the pulmonary artery known as the ductus arteriosus. This vessel closes shortly after birth when the baby resumes breathing on their own. In some cases, they do not, and it is called a patent ductus arteriosus and may require surgical intervention.
• Coarctation of the aorta: In this problem, a very small segment of the aorta is found to be narrower than usual causing problems in blood flow and can later give rise to high blood pressure problems.
• ASD or atrial septal defect (ASD): A hole in the left and right atria is called an ASD. This defect allows the mixing of pure and impure blood which will ultimately give rise to arrhythmias.
• VSD or ventricular septal defect (VSD): Presence of a hole in the wall between the left and right ventricles which allows the mixing of oxygen laden blood and impure blood which later can give rise to complications.
• Tetralogy of Fallot: It has four defects in the heart of newborn which causes cyanosis (turning blue in color).
• Tricuspid atresia repair: In this condition, the tricuspid valve in the heart is found to be either missing, narrow or deformed. As a result, babies born with this tend to grow blue due to the problem of sending blood to the lungs for carrying oxygen.
• Hypoplastic left heart repair:  This is a severe heart defect and can cause death if left untreated. This has a poorly developed left heart and usually does not have any other defects associated with it.

In closed-heart surgeries, it is still necessary to open the chest, but not to stop the heart or using the heart-lung bypass machine. Most closed-heart procedures deal with major blood vessels, such as the aorta or pulmonary arteries. Let us take a look separately in the two kinds of close heart surgeries- Corrective and palliative surgeries.

In patent ductus arteriosus condition, first medicines are used for the closure and if it does not work then other corrective methods are used.

The surgeon can make a cut in the groin and insert a catheter into the infant’s ductus arteriosus artery. Through this a small metal is inserted to block the blood flow and the problem is corrected.

In another kind, a small surgical cut on the left side of the chest is done. Once the PDA is located the surgeon ties or clips or divides and cuts it.

To repair coarctation of aorta, patient can be treated by cutting the narrow section and make it bigger with a patch which is synthetic in nature.

The second way to deal with this problem is to cut the narrow region and stitch the remaining ends.

The third way would include subclavian flap where after cutting the narrow part, a patch is taken from the left subclavian artery to make that portion large.

In a fourth way, a tube is connected to the normal sections of the aorta on both sides of the narrow region so that blood can flow normally.

Another non-invasive method is inserting a stent with a balloon at the tip to help open the artery at the constricted region.

To repair the ASD surgeon makes a cut in the groin and inserts a blood vessel to access the heart. Two devices shaped like umbrellas are implanted on the right and left sides of the septum. They are attached to each other to close the holes.

To repair VSDa patch can be placed on the hole via a stent inserted through the groin of the patient.

To repair Tricuspid valve defect series of shunts and surgeries may be required to allow the blood to flow into the lungs. For this surgeon may require repair or replace the tricuspid valve or insert a shunt to allow blood to get into the lungs.

To repair a hypoplastic left heart, three series of surgeries may be required. In the first, one vessel is formed from the aorta and pulmonary artery. This new vessel is responsible for carrying blood to the lungs. Second one is called Fontan operation and is done when the baby is 4 to 6 months old. While the third must be done a year later from the second. The series of operations are considered to be quite complicated.

Closed heart surgeries are mostly performed on children who cannot take care of themselves. In such cases, guardians of the infant or child should be aware of the procedures involved. Total medical history must be discussed with the surgeon and some of the following tests are to be conducted.

• Carotid ultrasound: blockages are checked in the artery supplying the neck.
• Chest X-Ray: This test aims to find out the size and shape of organs in the chest (lungs and heart)
• EKG: This test aims to find out irregularities in the heartbeats.
• Blood work: This has to be done in order to aid immediate blood transfusions if required during the surgery due to excessive loss of blood.
• Dental clearance: Prosthetic valve infections can happen through oral contamination. So, if valve replacements are happening through a closed surgery it is very important that dentists should thoroughly check for any oral bacterial infection.

Closed heart surgeries involve shorter stay but still, the duration is calculated by the potential for complications that may arise on the basis of the patient's health prior to surgery.6 to 8 weeks recovery period is general time and nutrition plays a very valuable role in this.

Most infants can be fed enterally via the gut after two days. But if the infant is not being fed milk or other baby foods then IV can be introduced for their nutrition. In worse situations, simple IV fluids comprising of sugar-water solution can also be administered.  IV nutrition in many cases replace sugars, fats, and proteins which the patients need. This kind of nutrition is called total prenatal nutrition or TNP.

In many situations, one may have to wait till the babies can be fed by mouth post the operation. This is dependent on what the infant was being fed with and the ability of the gut to work properly. Some kids may require additional nutritional support since in the healing process nutrition plays a critical role. Tubes or feeding tubes are placed via mouth or nose to the stomach to ensure adequate calorie intake by the patient for proper recovery.

On the basis of medication, some children are discharged, these medications are like water pills and other medications for the heart. The dosage may require some adjustments in consequent follow-ups with the surgeon or the cardiologist. Parents must strictly adhere to the instructions laid down by the doctors during the post-operative care of the infant. This can include wound check, body temperature check and other kinds of infection check.

For the first few days, frequent hand sterilization of parents handling the kid must be done and immunization must be avoided for the first 6 to 8 weeks after the surgery. Activities will be restricted for the time being to assist in timely healing.