Tuesday, July 14, 2009

Pediatric & AdultCongenital Heart Surgery

Surgical Procedures

A minimally invasive approach is the future of cardiovascular surgery. At California Pacific, we continue to pioneer techniques such as video cameras and robotics that enable the surgeon to see inside one’s heart and repair it. Using small incisions that only allow room for sterilized instruments, the surgeon’s hands and fingers rarely touch the patient’s tissue. As a result, patients who undergo minimally invasive surgery have:

> Reduced incidence of infection
> Shorter hospital stays
> Less scarring and better cosmetic results

The following are overviews of various pediatric heart surgeries our physicians perform. You can also read our Procedure Profile (pdf file) about surgery for congenital heart disease and our touch-free techniques.

Congenital Heart Disease Surgery

Congenital heart defects are common, affecting nearly one percent of all newborns. Having a congenital heart defect increases the risk for developing complications such as heart failure, endocarditis, atrial fibrillation and heart valve problems. Surgical treatment of a congenital heart defect varies depending on the specific diagnosis. Common surgical procedures include:

> Repair of holes in the heart
> Obstruction to blood flow
> Valve lesions
> Irregular heart rhythms
> A combination of the above conditions

Neonatal Surgery for Heart Conditions

One of our specialties is the repair of very complex neonatal heart conditions in premature (and low birth weight) babies. As a regional referral center, families from throughout the state come to California Pacific to receive care for a premature child or a fetus in which heart abnormalities are detected. We are also frequently asked to evaluate babies prior to birth when the fetus is recognized as having a heart defect. Common neonatal conditions corrected by our surgeon include ventricular septal defects (VSDs), Tetralogy of Fallot and total anomalous pulmonary venous abnormalities. These complex neonatal disease repairs are performed using minimally invasive surgery and often employ innovative brain protection strategies. Brain protection is critical to maintaining neurological function and learning potential. These capabilities may be compromised when blood flow to the brain is stopped—even briefly—during surgery.

Echo-Assisted Open Heart Surgery

Echocardiography or ultrasonography of the heart is routinely performed during all open heart procedures, regardless of size. Once the child or adult is fully under anesthesia, a probe is placed within the esophagus allowing for excellent views of the intra-cardiac structures. Occasionally when a neonate is very small, weighs less than 2.5kg, or when there is a history of esophageal pathology, an epicardial study is perfomed by placing a small probe directly on the heart. The advantage of such routine surveillance is the determination of subtle abnormalities and improved quality of the surgical repair. Rarely we can avoid an open heart procedure by using the echocardiographic pictures “real-time” allowing for procedures to be performed without incising the heart chambers but rather by placing precise instruments through small ports within the heart tissue.

Extracorporeal membrane oxygenation (ECMO)

ECMO is the use of an artificial lung (membrane) located outside the body (extracorporeal), that puts oxygen into the blood and then carries this blood to the body tissues (oxygenation). As the heart improves, the amount of blood flow through the extracorporeal membrane oxygenation circuit can be decreased, allowing the heart and lungs to do more of the work. California Pacific Medical Center was the site of the first successful ECMO case in 1977. Although rarely used, having ECMO readily available can permit heart muscle recovery in the most extreme cases of heart failure following complex open heart procedures or in cases of devastating lung failure.

Extracardiac Fontan

Extracardiac Fontan is performed for children or adults with single ventricle physiology. The Fontan procedure connects the right atrium to the pulmonary artery, thus separating the systemic and pulmonary venous circulations.

Intraoperative Stenting

In this procedure, the surgeon and interventional cardiologist work together to insert a stent (and open up a blockage), most often within the pulmonary artery. By using minimally invasive techniques to open the chest, the physicians can insert a larger stent that will last longer than one threaded through the groin vessels.

Minimally Invasive Heart Surgery

Minimally invasive surgery is typically performed through either a “keyhole” or “port-access” approach. A keyhole approach involves one midline incision (hemi-median sternotomy) across the lower two-thirds of the sternum. A port-access approach involves multiple 1-cm incisions which allow for insertion of either robotically controlled instrumentation (via the daVinci or Aesop robotic system) or handheld thorascopic instruments.

Surgical Approaches for Minimally Invasive Heart Surgery


Sometimes, one’s heart rhythm needs to be electrically stimulated so it will maintain a normal heartbeat. In these cases, our cardiovascular surgeon may implant a pacemaker, which helps to restore one’s heart rhythm and improve its ability to circulate blood through the body.

Ross Procedure

Some children and adults require an aortic valve replacement when other strategies have failed or are not indicated (i.e. balloon catheter dilation or valve repair). In these cases, a patient’s pulmonary valve is removed and used as the heart’s aortic valve and an artificial tissue valve is inserted in its place. This procedure is more complex than just replacing the valve with an artificial one, but has the advantages of:

> No artificial valve noises
> No need for anticoagulation or blood thinners
> Resistance to infection
> Potential for growth (an important consideration for neonates, children and young adults)

Mechanical Stabilization Technique
Vacuum Stabilization Technique
Heart Positioner

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