Pediatric cardiovascular surgery is the department where the heart anomalies (congenital cardiac diseases) which occur in the mother womb and may also threaten life after birth are treated with the surgical method. While the congenital cardiac diseases are observed approximately 8% of a thousand live births, most of the patients can see their mature ages thanks to the advancements ensured in the treatment. Thus, the patient spectrum contains a wide range from the infants to the adult age. 

It is usually possible to make a diagnosis with the ultrasonography which is made in the 20th week of the pregnancy. After birth, the diagnosis may be made or a detailed examination may be provided by the imaging methods like echocardiography, conventional angiography, computed tomography and magnetic resonance. We work with the other departments, especially by the pediatric cardiology, in a multidisciplinary way regarding diagnosis, treatment and patient follow-up.

Aortic Valve Stenosis

Aortic valve is between the left ventricle of heart and the aorta which ascends from there. The narrowness usually occurs because of the abnormal development of the valve. It may reveal itself by chest pain and fainting in the forthcoming period. If not treated, cardiac insufficiency and sudden death may occur. The initial option in the surgery is the repair of the narrowness. If it is not possible and the patient size allows, a cardiac valve implantation may be planned.

Atrial Septal Defect (ASD)

It is the case of presence of a hole between the right and left atriums. In this case, excessive blood runs into the lungs. Malnutrition and frequent pulmonary infection may be observed. If not treated, cardiac insufficiency, increase in the pulmonary blood pressure and rhythm disorder can occur in the advanced ages. The surgical treatment is performed usually during the preschool age of the patient and the hole is closed with a small incision.

What is ASD?

ASD is a hole which exists on the wall (septum) between the atriums of heart. If the ADS is small, it has a chance close within the first 18 months of the life within the rate of 80%.

How frequent is ASD seen?

It is seen approximately as 10% among the congenital heart diseases and it is two times frequent in girls than boys.

What are the types of ASD?

Primum: The hole is in the lower side of the wall between the atriums.

Secundum: The hole is in the middle area of the wall between the atriums, this is the most frequently observed type.

Sinus Venosus: The hole is near to the venous blood vessel which carries blood to the heart, this is the rarest type.

What are the symptoms of ASD?

It does not give any indications in many children. Shortness of breath, fatigue, retarded development and growth may be observed.

When is the ASD operation performed?

The operation is usually performed during the preschool age (2-5 years).

What happens if the ASD operation is not performed?

An excessive amount of blood runs into the lungs and it may cause a permanent damage there (Eisenmenger Syndrome). Cardiac insufficiency, rhythm disorder and stroke (paralysis) may be observed.

What is done during an ASD operation?

The hole is closed with a patch formed from the patient’s own cardiac membrane or by a direct stitch.

What are the results of ASD operations?

The results are quite decent and the success rate is over 99%.

How is the process after an ASD operation?

The process of recovery is often rapid and the complications (unwanted side-effects) are seen rarely. In general, patients are discharged within two weeks after the operation. They can live a normal life without any limit on their activities.

Atrioventricular Septal Defect (AVSD)

It is the case of presence of a large hole both between the atriums and between the ventricles. An excessive amount of blood runs into the lungs. Besides, the valves which are normally separated between both of the ventricles and atriums are united in this case. There may be insufficiency in the valves. This is seen more frequently in the patients with Down syndrome. Excessive breathing, perspiration, repetitive pulmonary infection and retarded development can be observed. If not treated, a permanent pulmonary damage caused by the increased blood pressure in the lungs and cardiac insufficiency may develop. The surgical treatment is performed on the patients when they are approximately 6-months old and the hole is often closed by a patch, the united valves are also separated. If there is any insufficiency in the valves, a repair can be planned. In the risky patients, the narrowing of artery of lungs (pulmonary artery banding) without using heart-lung machine (closed-heart surgery) may be taken as the initial option.

Coronary Artery Anomalies

The coronary arteries are the arteries which nourish the heart. They are normally separated from the aorta as two separated roots. While there are many variations of these anomalies, they may reveal themselves with the symptoms like perspiration, nutrition problems and chest pain. One of the frequently observed forms of it is the situation names as the abbreviation of ALCAPA, which is the left coronary artery origination from the pulmonary blood vessel. This may cause cardiac insufficiency and sudden death. The method of operation is decided according to the type of anomaly.

Hypoplastic Left Heart Syndrome (HLHS)

This is a disease with serious retarded development in the left atrium, ventricle, mitral and aortal valves and the main aorta of the body. These patients generally receive a 3-stage treatment. The first stage is performed when the patient is in the neonatal period and it is a complex procedure (Norwood operation) which enables the right atrium to pump blood both to the body and to the lungs by the help of an artificial blood vessel (graft). The second stage is performed when the patient is approximately 6-months old and the venous blood which came from the upper side of the body is connected to the pulmonary artery (Glenn operation). The third stage is performed after the patient starts to walk, within the ages of 2-5 and the venous blood which came from the lower part of the body is connected to the pulmonary artery via an artificial blood vessel (Fontan operation). In case of the risky patients, the hybrid intervention which is consisted of the narrowing of both of the pulmonary artery (bilateral pulmonary artery banding) and application of stent on the ductus blood vessel may be planned without using heart-lung machine (closed-heart surgery).

What is Hypoplastic Left Heart Syndrome?

This is a disease with serious retarded development in the left atrium, ventricle, mitral and aortal valves and the main aorta of the body.

What is the frequency of Hypoplastic Left Heart Syndrome?

HLHS is seen 7-9% of the babies who were born with congenital heart diseases.

How is the diagnosis of Hypoplastic Left Heart Syndrome made?

The diagnosis of this disease can be made even in the prenatal period. Echocardiography is sufficient to put the final diagnosis.

Can it be diagnosed in the mother’s womb? Yes

How is the treatment of Hypoplastic Left Heart Syndrome? Norwood procedure Bidirectional Glenn procedure Fontan procedure.

The first stage is performed when the patient is in the neonatal period and it is a complex procedure (Norwood operation) which enables the right atrium to pump blood both to the body and to the lungs by the help of an artificial blood vessel (graft). The second stage is performed when the patient is approximately 6-months old and the venous blood which came from the upper side of the body is connected to the pulmonary artery (Glenn operation). The third stage is performed after the patient starts to walk, within the ages of 2-5 and the venous blood which came from the lower part of the body is connected to the pulmonary artery via an artificial blood vessel (Fontan operation)

Is the Hypoplastic Left Heart Syndrome a genetic condition?

The genetic factors have a remarkable effect on the congenital heart diseases.

Is a prenatal treatment of Hypoplastic Left Heart Syndrome possible?

While there are studies on this topic, the decent results which can be a routine could not be obtained.

When do the children who had a Hypoplastic Left Heart Syndrome operation recover?

If successful results could be obtained after the 3 stages of the treatment of this disease, lives of the children may be more stable.

Are Hypoplastic Left Heart Syndrome operations risky?

They are among the riskiest operations of pediatric cardiovascular surgery.

Interrupted Arcus Aorta (IAA)

This is the interruption of the aorta in the section of giving the head and arm blood vessels after coming out of heart. If the blood flow to the lower part of the body cannot be sustained because of the interruption, there may be the risk of serious circulatory impairment and death. Generally there is a hole between the ventricles. The surgical treatment is generally performed when the patient is in the neonatal period by taking the interrupted blood vessel out and  throughout stitching the remained parts (patches may be needed), and if existed, the hole in the heart is closed.

Newborn, Infant and Adult Congenital Heart Surgery

Adult congenital heart surgery deals with the treatment of patients with congenital heart disease that have not been diagnosed until adulthood and patients who had congenital heart surgery as children and require additional intervention in adulthood. There is a close collaboration between cardiac surgeon and cardiologist who work together for treatment of each patient.Common interventions include;

abnormal pulmonary vessel repair, surgery for pulmonary valve, aortic coarctation repair and atrial septal defect closure.

Patent Ductus Arteriosus

Patent Ductus Arteriosus is a blood vessel located between the aorta and pulmonary artery and it is needed for the blood circulation in the prenatal period. It loses its function after delivery and closes naturally within 72 hours. When this blood vessel remains open, the situation is called patent ductus arteriosus. Excessive breathing, retarded development and repetitive pulmonary infection may be observed. If not treated, it may cause increased pulmonary blood pressure and cardiac insufficiency. Usually the surgical method is entering the area from a side between the ribs and closing the PDA by strapping after finding it.

Single Ventricle Physiology Anomalie

In case of these diseases, a single ventricle has undertaken the heart’s mission of pumping instead of two. Additional anomalies often accompany to this situation. Generally a 3-stage treatment is applied on these patients. The first stage is applied when the patient is 0-3 months old generally; the pulmonary artery is narrowed if the blood flow into the lungs is excessive (pulmonary artery banding), an artificial blood vessel is placed between the body artery and pulmonary artery if the blood flow into the lungs is not sufficient (shunt operation). The second stage is applied hen the patient is approximately 6 months old and the venous blood which comes from the upper side of the body is connected with the pulmonary artery (Glenn operation). The third stage is performed after the patient starts to walk, within the ages of 2-5 and the venous blood which came from the lower part of the body is connected to the pulmonary artery via an artificial blood vessel (Fontan operation).

TAPVR

Normally the arterial blood which comes from the lung spreads into the left atrium via the pulmonary veins and pumped into the body via the left ventricle. In case of this anomaly, the pulmonary veins do not have a direct connection with the left atrium. This connection is provided by the hole which is located between the two atriums of the heart. This may cause symptoms like excessive breathing, repetitive pulmonary infection and nutritional problems. If not treated, it may cause an increase in pulmonary blood pressure, cardiac insufficiency and death. The surgical treatment is generally performed when the patent is in the neonatal period, the pulmonary veins are united with the left atrium and the hole is closed.

Tetralogy of Fallot (Blue Baby Syndrome)

This is the most frequently observed disease among the congenital heart diseases which cause empurpling. It has 4 components: hole between ventricles, the aorta which has slipped onto the right side, narrowness of right ventricle outlet way and thickening of left ventricle muscle. There is shortness of blood in lungs. Generally, the empurpling increases by crying and effort. Empurpling seizures, fainting and sudden death may be observed. The surgical treatment is applied when the patient is approximately 6-months old and the hole is closed by a patch, the narrowness of right ventricle outlet way and thickening of muscle are repaired. In this process, it is aimed to protect the pulmonary valve between the right ventricle and pulmonary artery as far as possible and repair it if possible. In case of the risky patients, connecting the body artery and pulmonary artery via an artificial blood vessel (shunt operation) can be chosen as the first option without using heart-lung machine (closed heart surgery).

What is the Tetralogy of Fallot treatment?

A complete readjustment is performed if the vascular structure of lungs has been developed decently; if not, the shunt operation is executed. During the complete readjustment operation, the anomalies in the hart are corrected by the open-heart surgery. In case of the shunt operations, the aim is to develop the underdeveloped pulmonary blood vessels and ensure the sufficient blood flow into the lungs.

How the Tetralogy of Fallot operations is performed?

During the operation, the hole between the ventricles (VSD-ventricular septal defect) is closed. The outlet way of the right ventricle, that is, the thickened muscle stripe which is in excessive amount right under the main pulmonary artery is cut. In addition to this, the pulmonary blood vessel can also be widened and the sufficient level of oxygen is ensured to run into the lungs. The structure of pulmonary valve is tried to be protected with the new surgical methods.

In what age the Tetralogy of Fallot operations is performed?

They are generally performed when the patient is older than 6 months.

How many hours does a Tetralogy of Fallot operation take?

A Fallot Tetralogy operation usually takes approximately 4 hours.

What are the risks of a Fallot Tetralogy operation?

Some children may experience rhythm disorders after the tetralogy of fallot operation. Sometimes the ventricles may not be closed completely. In some children, the right ventricle outlet way narrowness cannot be solved completely. A backwards leakage from the pulmonary valve to the right ventricle may happen. The right ventricle grows according to the amount of leakage and an intervention may be needed in this case. In the future, there may be another need for a new surgical intervention because of the pulmonary blood vessel valve insufficiency and narrowness.

What is the shunt operation treatment for the Tetralogy of Fallot?

It is the process of connecting the body artery and pulmonary artery via an artificial blood vessel without using a heart-lung machine (closed heart surgery). It is usually performed on the patients whose lungs have blood insufficiency with frequent empurpling episodes within the range of 0-3 months. It is a palliative operation. When the patient is older than 6 months, the conventional correcting operation is performed again.

What are the important points to be careful after the Tetralogy of Fallot operation?

Some children may experience rhythm disorders after the tetralogy of fallot operation. This and the similar problems should be taken under control with routine follow-up controls. After the operation of Tetralogy of Fallot (Blue Baby Syndrome), a leakage may be experienced in the pulmonary valve, that is, the pulmonary main aorta valve. In this case, excessive blood may run into the right side of the heart according to the type of leakage. In these patients, cardiac insufficiency and rhythm disorder may be experienced after a certain time. Thus,  an intervention may be needed for these patients in the future.

Are the children who had a tetralogy of fallot operation be able to continue their normal lives?

Children live approximately a normal life after tetralogy of fallot treatment.

What is the life expectancy of the children who had a tetralogy of fallot operation?

The children who received a successful tetralogy of fallot operation live approximately as much as healthy children.

What happens if the tetralogy of fallot treatment is not received?

When Tetralogy of Fallot is not treated, the symptoms of cardiac insufficiency may be experienced because of the malfunction of the right ventricle. Besides, the empurpling of the child may increase in time. While some complications are experienced because of the empurpling, the rhythm disorders which are named as arrhythmia can also be observed. In case of the children whose treatment is late, the survival chance during and after the operation decreases.

Are the children who received tetralogy of fallot treatment able to do sports?

They can engage in sports except the heavy ones.

How long should the controls of the children who had a Tetralogy of Fallot operation continue?

The follow-ups of the children who had a Tetralogy of Fallot operation are done yearly for lifetime.

Can the patients who had a Tetralogy of Fallot operation have baby?

Generally, the women who had a tetralogy of fallot operation tolerate the pregnancy decently. On the other hand, in case of women whose right ventricle has enlarged significantly because of the serious insufficiency in the pulmonary valve, a pulmonary valve operation may be needed before the pregnancy.

Do the children who had a Tetralogy of Fallot operation need to have another operation?

If a protective operation for the pulmonary valve is performed on the children who had a tetralogy of fallot operation before, there may be no need for another operation in the future. On the other hand the right ventricle enlarges gradually because of the valve leakage after some operations in which the pulmonary valve function could not be protected or disordered. A second operation may be needed in these children.

Transposition of the Great Arteries

In this disease, the pulmonary artery, which must run from the right ventricle, comes out of the left ventricle, and the aorta, which must run from the left ventricle, comes out of right ventricle, thus they have changed places. The arterial blood which has to run into the body comes into the lungs, and the venous blood which is to go into the lungs runs into the body. Thus, neonatal empurpling may be observed. The surgical treatment is usually performed during the neonatal period and the blood vessels which came out abnormally are transferred to their normal places (Jatene operation). In case of the patients who applied late, the procedure of switching the atriums (Senning operation) may be planned.

What is TGA?

Normally, the pulmonary artery comes out of the right ventricle and enables the cleaning (giving oxygen into) the blood by carrying the venous blood into the lungs. Again normally, the aorta comes out of the left ventricle and carries the arterial blood into the body. The aorta and pulmonary artery are names as the great arteries. In case of TGA, the great arteries come out of the ventricles in a reverse position; the aorta comes out of the right ventricle and the pulmonary from the left. Thus, the venous blood which returns from the body veins to the heart is pumped into the body without stopping by the lungs to be cleaned. This is not compatible with the life, so the venous and the arterial blood should be mixed to keep the infant alive. This is possible via the hole between the atriums (ASD-atrial septal defect), the hole between the ventricles (VSD-ventricular septal defect) or the connection between the aorta and pulmonary artery (PDS-patent ductus arteriosus).

What is the frequency of TGA?

The frequency of it is approximately 5 in ach 10.000 live birth.

What are the symptoms of TGA?

Cyanosis is observed on the skin, nails and lips as parallel with the decrease level of oxygen in the blood. Rapid breathing (  tachypnea), loss of appetite, weak pulse, retarded growth and development may be observed.

When the operation of TGA is performed?

It is preferably performed during the first week of life. If there is a hole between the ventricles of heart (VSD), this duration may be extended until a month.

What is performed during the TGA operation?

The most frequently applied method is the arterial switch operation. After separating the pulmonary artery and aorta which came from the heart in the wrong way by incision, they are stitched on their normal place. Also the coronary arteries, which nourish the heart, are connected with the newly formed aorta. If there is any hole in the heart, it is closed.

What happens if a TGA operation is not performed?

The sufficient oxygen cannot be provided to the body (hypoxia) and cardiac insufficiency develops. Half of the patients pass away within the first month, and 90% of them before the age of 1.

What is the process after a TGA operation?

The patients are discharged from the hospital within approximately two weeks after the operation. More than 90% of the patients can see their mature ages and live a healthy life.

Truncus Arteriosus

Under normal conditions, the main arteries of body and lungs come out of the heart separately, but in case of this disease the blood vessel comes out in a single root and splits up later. The lung receives excessive blood. There is nearly always a hole between the ventricles. If not intervened during the early period, increase of the pulmonary blood pressure, permanent damage in the lungs and cardiac insufficiency may develop. The surgical treatment is generally applied when the patient is in the neonatal period. During the operation, the connection of the blood vessel which came out as a single branch from the heart with the lungs is interrupted and it is made to nourish only the body; the nutrition of the lungs is ensured via an artificial blood vessel which is put between the right ventricle and pulmonary artery. The hole in the heart is closed.

Why should I choose Memorial for pediatric cardiovascular surgery?

Under the chairmanship of Prof. Dr. Hakan Ceyran, who is recognized with his studies which are famous worldwide on the topic of Pediatric Cardiovascular Surgery, Department of Pediatric Cardiovascular Surgery at the Memorial Ataşehir Hospital provides services with their experienced team consisted of the pediatric intensive care specialists and nurses, modern technologies and multidisciplinary approach. The department comes to the forefront as one of the significant reference centers in the world regarding Pediatric Cardiovascular Surgery. At Memorial Ataşehir Hospital, the privilege of receiving treatment at a comfortable space for children with the special operation room, where only Pediatric Cardiovascular Surgery operations are performed, and the intensive care unit is provided.

Ventricular Septal Defect (VSD)

It is the case of presence of a hole between the two ventricles of heart. Excessive blood runs into the lungs. The repetitive pulmonary infection, retarded development, breathing and perspiring excessively may be seen. In not treated, increase in the pulmonary blood pressure and cardiac insufficiency may develop. Usually, the operation is performed on the patient when they are approximately 6-months old and the hole is closed. In the risky patients, the narrowing of main artery of lungs (pulmonary banding) without using heart-lung machine (closed cardiac surgery) may be taken as the initial option.

What are the reasons of VSD?

With the genetic factors like chromosome anomalies and consanguineous marriages, the unconsciously taken medications during pregnancy may also cause VSD.

What are the symptoms of VSD?

The babies with VSD generally reveal symptoms like frequently repetitive pulmonary infections, retarded growth and development.

How is the diagnosis of VSD made?

The systolic murmur which is heard during the examination usually makes the provisional diagnosis to be made. The final diagnosis is made by the echocardiography.

How is the treatment of VSD?

There is no medical treatment of VSD. While some of the serious VSD’s which are not closed themselves may be closed by the method of angio/umbrella, most of them are closed by the open-heart surgery method.

Is ASD or VSD more dangerous?

VSD is more dangerous. ASD may remain asymptomatic for many years. While pulmonary hypertension is seen in the advanced ages in case of ASD, it can be observed in the early ages, even in the infant period in case of VSD and it may prevent the chance of receiving treatment.

How is a VSD operation performed?

VSD operations are performed by open heart surgery, that is, stopping the heart. During this process when the pulmonary and cardiac functions are stopped, these missions are carried by the heart-lung machine.

What is the millimetric measure of the heart hole needed for an operation?

While the size of heart hole is important, but the decisive factors are the blood amount which runs into the lungs and the consequent right/left heart shunt rate rather than the millimetric measurement of the hole.

What should be watched out in the babies who had VSD operation?

It is recommended to keep the babies who had the operation in the health places away from ill persons and crowds for two weeks.

How long does it take a VSD operation?

It takes approximately 3 hours to enter into the operation room and leave there.

Are the persons who had a VSD operation able to do sports?

Doing sports which need heavy efforts is not recommended during the first three months after the operation. After this period, the patient can do whatever sport they want under the normal living conditions.

What are the potential risks seen in infants after VSD operation?

After VSD operations the cases of cardiac rhythm disorders or incomplete closure of the hole can be seen with quite a minimal rate.

Is there a drug therapy for VSD?

There is no drug therapy to close VSD. Drug therapy is applied in case of cardiac insufficiency as a result of this disease and pulmonary hypertension which occurs when the VSD has not been treated.

When VSD is closed in infants?

More than a half of the small holes can close naturally. A close and diligent follow-up and treatment is needed for the holes which have not closed above the age of 1.