Introduction
Congenital heart defects are problems in the structure of the heart or the large blood vessels that are present from birth. They range from small holes that need only observation to complex defects that need surgery in the first days of life.
Paediatric cardiac surgery corrects or improves these defects. It is performed by surgeons, anaesthetists and intensive-care teams who are trained specifically in the care of babies and children.
Why the procedure is needed
Depending on the defect, a child may have:
- Fast breathing, difficulty feeding, sweating while feeding and poor weight gain
- A bluish colour of the lips and skin (cyanosis)
- Frequent chest infections or tiring easily during play
- A heart murmur found at a routine check-up
- Heart failure symptoms, or poor growth, if the defect is large and left untreated
Who may benefit
- Newborns, infants and children with congenital heart defects that need surgical correction or an operation to improve blood flow
- Children with defects such as a hole in the heart, abnormal connections of the large vessels, valve problems or complex single-ventricle conditions
- Teenagers and adults with a congenital defect that was not treated, or that needs further surgery
- The timing and type of surgery are chosen by a paediatric cardiologist and a congenital heart surgeon after a detailed assessment
Approaches to treatment
- Complete repair
- For many defects, such as ASD, VSD or Tetralogy of Fallot, one operation can correct the problem.
- Staged surgery
- Complex defects may need two or three planned operations over the first few years to reach a stable circulation.
- Palliative operations
- Some operations, such as shunts, improve blood flow temporarily until a full repair is possible.
- Catheter alternatives
- Some defects can be treated through a catheter without open surgery, depending on the child and the defect.
- Specialist team
- Results are best in centres that regularly treat congenital heart disease and have paediatric intensive care.
Procedure overview
Step 1: Diagnosis
Often made by echocardiography before or soon after birth. CT, MRI or catheter studies may add detail. The family meets the paediatric cardiology and surgical team.
Step 2: Planning
The team decides when and how to operate, and explains the plan and the risks to the family.
Step 3: Anaesthesia
A paediatric anaesthetist provides general anaesthesia with careful monitoring suited to the child's size.
Step 4: Surgical repair
Access is usually through the breastbone, using the heart-lung machine. The specific repair depends on the defect.
Step 5: Paediatric intensive care
After surgery, the child is cared for in a specialised intensive care unit, with breathing support, pain control and close monitoring.
Step 6: Growing up with the repair
Regular follow-up with paediatric and later adult congenital cardiology is planned for life.
Clinical advantages
- Can correct or greatly improve the heart defect
- Allows better growth, feeding and activity
- Early treatment may protect the heart and lungs from long-term damage
- Many children go on to live active lives, with follow-up
Risks and considerations
Every operation carries risk. The points below are general; your own risk depends on your health and on the operation you need.
- The general risks of heart surgery: bleeding, infection, rhythm problems and breathing problems
- Higher risk in very small babies and in complex defects
- Possible need for further operations or catheter procedures later in life
- Heart block that may need a pacemaker in some repairs
- Risk depends on the defect, the child's condition and the centre's experience
Frequently asked questions
Does every heart defect need surgery?
No. Some small defects close by themselves or only need regular follow-up. Your paediatric cardiologist will advise.
When should surgery be done?
It depends on the defect. Some are repaired in the first weeks of life, others in infancy or childhood. The team will advise the best timing for your child.
Will my child live a normal life?
Many children do well and lead active lives, but advice differs by defect. Regular follow-up is important.
Can the defect be found before birth?
Many are found by a detailed scan during pregnancy (fetal echocardiography), which helps the family and the team prepare.
What should I tell my child's doctor?
Report poor feeding, fast breathing, blue colour, frequent infections or poor weight gain without delay.
Patient-friendly summary
Paediatric cardiac surgery corrects or improves heart defects that children are born with, sometimes in one operation and sometimes in planned stages. Outcomes are best with early diagnosis, a specialist congenital heart team and lifelong follow-up. Any child with a suspected heart defect should be seen by a paediatric cardiologist.