Treatment options depend on the disease present and the severity with various other factors. Some of the cardiac procedures done in India with success for children are Norwood procedure, Ross procedure, cardiac transplant, Neonatal repairs, Arterial switch, VAD, ECMO and so on.

A child may have serious congenital heart defects or less serious heart defects and thus the type of surgery and urgency can be decided by the paediatric cardiac surgeon.

Serious congenital heart defects become evident during the first few hours, days, weeks or may be months after the birth. Symptoms of serious heart defects may include loss of healthy skin, colour leading to pale grey or blue colour of the skin, rapid breaths, swelling in the legs, abdomen or areas around the eyes, less than normal weight gain.

Less serious congenital heart defects are often not diagnosed early. Some may get noticed in few years, while some defects are noticed as late as 25-30 years of age. This is because of no signs and symptoms of the disease. They are usually discovered accidentally. Few of the symptoms that the child may have are easily becoming short of breath or tiring during exercise or activity, swelling in the hands, ankles or feet or built-up fluid in the heart or lungs.

If a child presents with symptoms like shortness of breath, early tiring with little exercise of activity, exercise or activity, swelling in the hands, ankles or feet or built-up fluid in the heart or lungs, the child should be thoroughly evaluated by the physician and a cardiologist who would advise if the child needs a corrective heart surgery.

There are various techniques to perform pediatric heart surgery, depending upon the heart defect the child is suffering from and the medical condition and age of the patient. Besides, the defects can be inside the heart or in large blood vessels outside the heart. Sometimes, one surgery may be enough to repair the defect, but sometimes a series of procedures are required to completely correct the defect.

Three different techniques are used to fix congenital heart defects in children described as below:

• Open-heart surgery is when the surgeon uses a heart-lung bypass machine. It is done under general anesthesia
  • Incision is made through the breastbone (sternum)
  • Tubes are used to re-route the blood through a special pump called a heart-lung bypass machine. This machine adds oxygen to the blood and keeps the blood warm and moving through the rest of the body while the surgeon is repairing the heart.
  • Using the machine allows the heart to be stopped. Stopping the heart makes it possible to repair the heart muscle itself, the heart valves, or the blood vessels outside the heart. After the repair is done, the heart is started again, and the machine is removed. The breastbone and the skin incisions are then closed.
• Thoracotomy- Also known as closed heart surgery, during this type of surgery, the incision is made on the side of the chest, between the ribs. This type of surgery is done using special instruments and a camera.
• The other technique uses small tubes to be inserted in the heart through an artery in the leg. Only some heart defects can be repaired this way.

The child would stay in the ICU for 3-4 days after the procedure and another week or so in the hospital. The child would need about 3 or 4 more weeks at home to recover. For larger surgeries, recovery may take 6 to 8 weeks.

Pain after surgery is normal and would be controlled with medications. Most children behave differently after heart surgery- they may be irritable, clingy or cry even if they were not doing this before the surgery.

The child should not do any activity where there are chances that he/ she may fall or take a blow to chest- bicycle, skateboard riding, swimming and sports should wait for at least 4 weeks. If there has been an incision through the breast bone, they should be careful in using their arms. They should not do activities like pulling or pushing, lifting arms above the head, lifting heavy things. You should not lift the child by arms.

The results of a corrective heart surgery in children are quite good. Most of the kids lead a normal and healthy life after heart surgery. They can do the same things that the children can do without a congenital heart disease.

The stay required in India depends upon the type of problem and the surgery advised by the surgeon. You may need to stay for about three to six weeks for a paediatric cardiac surgery in India.