Aftercare of the children who have undergone cardiac procedures and surgeries is as important, and in some occasions, more important than the actual procedure performed.
The primary care pediatrician should be well versed with the cardiac anatomy and the ongoing physiology following the cardiac surgery. Some general rules applicable to all children following cardiac inteiventionlsurgery:
1) All common ailments should be treated as it is done for any other child. Most children can begin or continue their routine immunizations about one month after their surgeiy.
2) Restriction of physical activities depends on the underlying uncorrected
cardiac lesion and the treating cardiologist should be consulted in this regard.
3) Pericardial collection can develop following discharge after cardiac surgeiy.This is particularly common after closure of ASD. The collection may occur as early as a few days following discharge.
4) Except patients operated for simple left to right shunts (ASD, VSD, PDA)all other children will need infective endocarditis (IE) prophylaxis for an indefinite period irrespective of the completeness of the repair.
5) Late unexpected death is a known complication in any complex congenital heart repair and the majority is due to arrhythmias. Checking the regularity of the rhythm is an important aspect of the follow-up in these children.
Follow-up has to be tailored to the individual patient.
Patent ductus arteriosus (PDA) interruption (surgical or transcatheter intervention):
It is a curative procedure.
.
Atrial Septal Defect
Following device closure: These patients receive aspirin (3-5mg/kg/d) for a period of six months during which the device would get endothelialized (5).
Ventricular Septal Defect (device or surgical closure)
Potential problems following a VSD closure include residual VSD or residual pulmoniuy hypertension. The residual VSDs are generally small with insignificant left to light shunt. However it could result in a loud clinical murmur. Parents need to be counseled regarding this and the child should be advised IE prophylaxis for as long as the murmur is audible. Spontaneous closure is unusual. If there are no issues after VSD closure one year after of surgery, these children do not need to follow-up with the cardiologist unless there are specific concerns.
Valvar Pulmonary Stenosis
Balloon dilatation is the procedure of choice in this condition.
Congenital Heart Disease
Valvar Aaortic Stenosis
Unlike valvar pulmonary stenosis, congenital aortic stenosis is a progressive disease and surgical or balloon valvotomy is largely a palliative procedure to reduce the LV strain and sudden death. This allows children grow to an older child or adult when aortic valve replacement would be needed.
Coarctation of Aorta
Children presenting in neonatal and infancy period would have undergone surgical repais while older children would have undergone balloon dilatation of the coarctation.
Tetralogy of Fallot
The surgical outconle of this condition is excellent and the 35 year survival rate is 85 per cent, which is just below the normal survival rate.
ID-Transposition of Great Arteries
Following Arterial Switch Procedure (Jatene)
This results in anatomical and physiological correction of D-TGA, except for the semilunar valves where the morphological pulmonary valve becomes the 'neoaortic' valve and the morphological aortic valve becomes the 'neopulmonary' vrilve. The transfer of coronaries from original aorta to neoasota is a mandatory component of the operation. Today a 15 year survival probability in excess of 90 per cent can be expected.
Operations Requiring the Use of Conduits
Tetralogy with Pulmonary atresia, transposition or selected varieties of double outlet right ventricle with VSD and PS, selected patients with corrected transposition and VSD with PS.
These conduits (pulmonary homograft or xenografts) do not grow with time and will need to be replaced over time as it is outgrown. Children on oral anticoagulation:Oral anticoagulation is advised for various indications. The common indications are: valve replacement surgery, patients with atlial fibrillation, primary pulmonary hypertension, and Eisenmenger syndrome. See section on anticoagulants.
The primary care pediatrician should be well versed with the cardiac anatomy and the ongoing physiology following the cardiac surgery. Some general rules applicable to all children following cardiac inteiventionlsurgery:
1) All common ailments should be treated as it is done for any other child. Most children can begin or continue their routine immunizations about one month after their surgeiy.
2) Restriction of physical activities depends on the underlying uncorrected
cardiac lesion and the treating cardiologist should be consulted in this regard.
3) Pericardial collection can develop following discharge after cardiac surgeiy.This is particularly common after closure of ASD. The collection may occur as early as a few days following discharge.
4) Except patients operated for simple left to right shunts (ASD, VSD, PDA)all other children will need infective endocarditis (IE) prophylaxis for an indefinite period irrespective of the completeness of the repair.
5) Late unexpected death is a known complication in any complex congenital heart repair and the majority is due to arrhythmias. Checking the regularity of the rhythm is an important aspect of the follow-up in these children.
Follow-up has to be tailored to the individual patient.
Patent ductus arteriosus (PDA) interruption (surgical or transcatheter intervention):
It is a curative procedure.
.
Atrial Septal Defect
Following device closure: These patients receive aspirin (3-5mg/kg/d) for a period of six months during which the device would get endothelialized (5).
Ventricular Septal Defect (device or surgical closure)
Potential problems following a VSD closure include residual VSD or residual pulmoniuy hypertension. The residual VSDs are generally small with insignificant left to light shunt. However it could result in a loud clinical murmur. Parents need to be counseled regarding this and the child should be advised IE prophylaxis for as long as the murmur is audible. Spontaneous closure is unusual. If there are no issues after VSD closure one year after of surgery, these children do not need to follow-up with the cardiologist unless there are specific concerns.
Valvar Pulmonary Stenosis
Balloon dilatation is the procedure of choice in this condition.
Congenital Heart Disease
Valvar Aaortic Stenosis
Unlike valvar pulmonary stenosis, congenital aortic stenosis is a progressive disease and surgical or balloon valvotomy is largely a palliative procedure to reduce the LV strain and sudden death. This allows children grow to an older child or adult when aortic valve replacement would be needed.
Coarctation of Aorta
Children presenting in neonatal and infancy period would have undergone surgical repais while older children would have undergone balloon dilatation of the coarctation.
Tetralogy of Fallot
The surgical outconle of this condition is excellent and the 35 year survival rate is 85 per cent, which is just below the normal survival rate.
ID-Transposition of Great Arteries
Following Arterial Switch Procedure (Jatene)
This results in anatomical and physiological correction of D-TGA, except for the semilunar valves where the morphological pulmonary valve becomes the 'neoaortic' valve and the morphological aortic valve becomes the 'neopulmonary' vrilve. The transfer of coronaries from original aorta to neoasota is a mandatory component of the operation. Today a 15 year survival probability in excess of 90 per cent can be expected.
Operations Requiring the Use of Conduits
Tetralogy with Pulmonary atresia, transposition or selected varieties of double outlet right ventricle with VSD and PS, selected patients with corrected transposition and VSD with PS.
These conduits (pulmonary homograft or xenografts) do not grow with time and will need to be replaced over time as it is outgrown. Children on oral anticoagulation:Oral anticoagulation is advised for various indications. The common indications are: valve replacement surgery, patients with atlial fibrillation, primary pulmonary hypertension, and Eisenmenger syndrome. See section on anticoagulants.
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