Congenital Heart Disease and Heart Surgery

In some cases, you or your child may need heart surgery to correct a congenital heart defect. Surgery may be needed to:

• Repair a hole in the heart, such as a ventricular septal defect (VSD) or an atrial septal defect (ASD)
• Close a patent ductus arteriosus (PDA)
• Repair complex defects, such as abnormal positioning or development of the major blood vessels near the heart
• Repair or replace a valve, such as a valve that is too narrow (stenotic) or too leaky (regurgitant)
• Widen narrowed blood vessels that are too narrow for normal blood flow, such as a narrowed aorta

Preparing for surgery

It’s important for you to be as healthy as possible before the surgery. During the two weeks before the day of surgery, try to avoid contact with people who have a cold or fever. If you develop a fever, cough or cold during that time, talk to someone on the cardiology or surgical team to decide if the operation should be delayed. 

You will be seen for preoperative counseling and testing about a week before the surgery. Common preoperative tests include:

• EKG
• Echocardiogram
• Chest X-ray
• Blood tests

Nurses, child life specialists and social workers are often available to answer your questions. A hospital tour before the operation may help you or your child better understand what to expect during the hospital stay. 

The surgeon’s office will let you know when to arrive. They will provide any special instructions you should follow to prepare for surgery. Generally, you won’t be able to eat or drink for several hours before surgery. 

The length of the operation and hospital stay will depend on your heart condition and the type of surgery.  

If you are preparing your child for surgery, you may help them feel more comfortable by bringing favorite toys, pictures, blankets, pillows or other reminders of home. Ask in advance about the hospital’s visiting hours and rules about who can visit your child. Many hospitals allow parents and guardians to stay overnight in their child’s room. If not, many offer overnight accommodations either within the hospital or close by.

In the operating room

A team that includes a cardiac surgeon, an anesthesiologist, other doctors, technicians and nurses will perform the heart surgery. While the surgeon performs the operation, the anesthesiologist provides anesthesia and monitors vital signs. 

During open-heart surgery, the team will use a heart-lung machine, also known as a cardiopulmonary bypass machine. The heart-lung machine allows blood to bypass the heart so the heart can be emptied, opened and repaired. The bypass machine:

1. Takes blood that is low in oxygen
2. Adds oxygen to it
3. Pumps the oxygen-rich blood back into the body

Once the heart-lung machine is running and the heart is emptied, the team will give you a medication to temporarily stop the heart from pumping. This allows the surgeon to open the heart and perform the needed repair. After the repair is complete, the surgeon closes the heart, allows it to refill with blood and restarts its pumping. Once the heart is beating normally on its own, the team will turn off and disconnect the heart-lung machine. 

Some heart procedures can be done without opening the heart chambers or using a heart-lung machine. These are called closed-heart surgeries.

Blood transfusions

Blood transfusions are often needed for heart surgery. All donated blood is carefully screened to match your blood type and to rule out infections, such as HIV and hepatitis. 

Blood is sometimes in short supply. You or your family and friends may be able to donate blood in advance, which may be used during your surgery.

In the intensive care unit

After surgery, you will go to the intensive care unit (ICU). Specially trained doctors, nurses and technicians will give you round-the-clock care as you recover. 

Your care team may perform blood tests, EKGs, echocardiograms and chest X-rays to monitor your heart function. You may also receive IV medications to:

• Support your blood pressure or heart rate
• Help your body remove extra fluid that can build up during open-heart surgery

You will be kept as comfortable as possible with pain medications and sedatives. 

Common types of monitoring and support used in the ICU include:

• Central venous line (CVL, CVC or right atrial line): A thin tube used to give medications, fluids or nutrition and to measure pressure in the large veins near the heart. It is placed into a large vein (usually in the neck, chest or groin). The tip rests in the large vein that leads into the heart (the vena cava).
• Arterial line: A small tube placed into an artery, usually in the wrist, groin or foot, to measure blood pressure continuously and to draw blood samples.
• Arterial blood gas (ABG): A blood test taken from the arterial line that measures oxygen, carbon dioxide and acidity levels. This helps the team check how well the lungs and heart are working.
• Oxygen saturation (pulse oximeter): A small monitor placed on a finger or toe that measures the oxygen level in the blood continuously.
• Mechanical ventilator (breathing machine): This gives oxygen and helps you breathe until you are fully awake and able to breathe well on your own. The ventilator delivers oxygen to the lungs through a special tube called an endotracheal tube. It’s placed down the throat into the windpipe.
• Continuous positive airway pressure (CPAP): This device delivers air or oxygen under steady pressure through the nostrils. This can keep the lungs expanded without the use of a mechanical ventilator.
• Nasal cannula: Soft tubes placed into the nostrils to give extra oxygen once you no longer need a ventilator or CPAP.
• Chest tube: A tube that’s placed through a small incision in the chest to remove air or fluid that collects around the heart or lungs after surgery. You may have one or more chest tubes. Your doctor will remove the tubes once the air and fluid drainage decrease.
• Foley catheter: A tube placed into the bladder to drain urine and to monitor how well the kidneys are working.
• Pacing wires: Small wires that are placed through the chest wall and attached directly to the heart. They can help regulate the heartbeat if an abnormal rhythm occurs after surgery.

Further hospital care

After leaving the ICU, most patients go to a hospital area that provides less intensive care. It’s often called “the floor” or “step-down unit.” Your heart rate and rhythm may still be monitored using a continuous EKG system called telemetry. You will be encouraged to cough, sit up, take deep breaths and use a breathing device called an incentive spirometer. These steps help keep your lungs expanded and reduce the risk of infections such as pneumonia. Engaging in normal activities, such as walking and going to the bathroom, will help speed your recovery. 

A mild fever during the first few days after surgery can be a normal response to healing. If the fever doesn’t go away, your doctors may run tests to find out the cause and how to treat it. 

At first, you may need pain medication. Pain often lessens within a few days after the operation. 

When the doctors are satisfied that you are getting better, it will be time to go home. You may be given pain or heart medications to take at home. Be sure you understand all your medications before you leave the hospital. 

What Happens After Heart Surgery? (PDF)

Taking care at home after surgery

The surgical team will explain how to care for the incision and what to expect during recovery. You will also receive guidance about activity levels, such as lifting, play, school attendance, gym class and sports.  

Follow all instructions you get about diet, medications and activity.  

You should call your surgeon or cardiologist if you or your child develops:

• Fever
• Chest pain
• Trouble breathing
• Redness, swelling or pus at the incision site
• Worsening pain
• Reduced activity level
• Poor feeding for infants

Schedule all recommended follow-up visits, including appointments with the cardiologist and surgeon. 

What Can I Expect When I Go Home After Heart Surgery? (PDF)