Fallot's Tetralogy Surgey | Child heart defect Treatment in India

Fallot's Tetralogy Surgey in India

Tetralogy of Fallot is the most common heart defect in children. The condition causes mixing of oxygen-poor blood with the oxygen-rich blood being pumped out of the heart and into the circulatory system of blood vessels.

·         The blood leaving the heart has less oxygen than is needed by the organs and tissues of the body, a condition called hypoxemia.

·         Chronic (ongoing, long-term) lack of oxygen causes cyanosis, a bluish color of the skin, lips, and membranes inside the mouth and nose.

The normal heart works as follows:

·         The heart is made up of 4 chambers: 2 upper chambers called atria and 2 lower, larger chambers called ventricles. Each atrium is separated from its paired ventricle by a valve.

·         The heart has a left and a right side. The left and right sides of the heart are separated by a septum (wall). The right side of the heart receives oxygen-depleted or blue blood returning by veins (superior vena cava and inferior vena cava) from the body.

·         The blood flows from the right atrium through the tricuspid valve into the right ventricle, which pumps it through the pulmonic valve into the pulmonary artery, the main artery to the lungs.

·         In the lungs, the blood absorbs oxygen and then returns to the left atrium through the pulmonary veins.

·         From the left atrium, the blood is pumped through the mitral valve to the left ventricle. The left ventricle pumps the blood out of the heart into the circulatory system via a large artery known as the aorta.

·         The blood moves throughout the body, supplying oxygen and nutrients to organs and cells.

·         Organs cannot work properly if they do not receive enough oxygen-rich blood.

The 4 abnormalities (tetralogy) of the heart described by Fallot include the following:

·         Right ventricular hypertrophy: Narrowing or blockage of the pulmonary valve and/or muscle under the pulmonary valve coming out of the right ventricle. This restriction to blood outflow causes an increase in right ventricular work and pressure, leading to right ventricular thickening or hypertrophy.

·         Ventricular septal defect (VSD): This is a hole in the heart wall (septum) that separates the 2 ventricles. The hole is usually large and allows oxygen-poor blood in the right ventricle to pass through, mixing with oxygen-rich blood in the left ventricle. This poorly oxygenated blood is then pumped out of the left ventricle to the rest of the body. The body gets some oxygen, but not all that it needs. This lack of oxygen in the blood causes cyanosis.

·         Abnormal position of the aorta: The aorta, the main artery carrying blood out of the heart and into the circulatory system, exits the heart from a position overriding the right and left ventricles. (In the normal heart, the aorta exits from the left ventricle.) This is not of major importance in infants.

·         Pulmonary valve stenosis (PS): The major issue with tetralogy of Fallot is the degree of pulmonary valve stenosis, since VSD is always present. If the stenosis is mild, minimal cyanosis occurs, since blood still mostly travels to the lungs. However, if the PS is moderate to severe, a smaller amount of blood reaches the lungs, since most is shunted right-to-left through the VSD.

Tetralogy of Fallot Symptoms

Most infants with tetralogy of Fallot develop cyanosis in the first year of life.

·         The skin, lips, and mucous membranes inside the mouth and nose take on a noticeably dusky blue color.

·         Only some infants with very severe obstruction of the right ventricle outflow turn blue at birth.

·         A small number of children with tetralogy of Fallot never turn blue at all, especially if the pulmonary stenosis is mild, the ventricular septal defect is small, or both.

·         In some children, the cyanosis is quite subtle and may go undetected for some time.

The following symptoms suggest tetralogy of Fallot:

·         Growth and development are slower, especially if the pulmonary stenosis is severe. Puberty may be delayed if the tetralogy is untreated.

·         The child usually tires easily and begins panting with any form of exertion. He or she may play for only a short time before sitting or lying down.

·         Once able to walk, the child often assumes a squatting position to catch his or her breath and then resumes physical activity. Squatting increases the pressure transiently in the aorta and left ventricle, causing less blood to move into the left ventricle, more out the pulmonary artery to the lungs.

Medical Treatment in India

Surgery is the primary way to correct the heart problem. Your child may be prescribed medication for tet spells. You will also be given information for dealing with future tet spells.

·         The child will be placed on his or her back in the knee-to-chest position to increase aortic resistance. The increased aortic and left ventricular pressure reduces the rush of blood through the septal hole from the right ventricle and improves blood circulation to the lungs, so more red blood reaches the tissues.

·         The child may be given oxygen through a face mask to increase the amount of oxygen in the blood.

Paediatric Cardiac Surgery | Paediatric Heart Surgery in India

Paediatric Heart Surgery in India

Sometimes heart surgery in children is required for repairing defects in the heart which a child might have born with (known as congenital heart defects) and heart diseases which he gets after birth, which require surgery. Pediatric Cardiac Surgery deals with operative procedures in the newborn and unborn children and youngsters suffering from cardiac dysfunctions, structural, functional and rhythm-related issues of the heart also.

Pediatric Cardiac Surgery often deals with heart problems in children, the cause of congenital heart diseases which are common heart ailments among new born children and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies, which result in different kinds of abnormalities related to the heart. Congenital heart disease is a cause of improper growth of the heart or blood vessels before birth.

Pediatric Cardiology Facilities

The Paediatric cardiology department of any hospital offers all non-invasive diagnostic and paediatric cardiac interventional services. The diagnostic modalities are inclusive of foetal echocardiography, transthoracic and transesophageal echocardiography, round the clock Holter, CT and MR angiography as well as diagnostic cardiac catheterisation. Cardiologists, cardiovascular surgeons, anesthesiologists and other specialists work closely together to care for newborn as well as unborn children suffering from cardio-vascular disorders who provide exceptional pre and post operative services.

Pediatric heart surgery often deals with cases of congenital heart disease. Congenital heart disease is a common heart ailment among new born children and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies. This leads to different kinds of abnormalities related to theheart. Congenital heart disease is a cause of improper growth of the heart or blood vessels before birth. Pediatric heart surgery deals with operative procedures dealing with newborn and unborn children and youngsters suffering from cardiac dysfunctions.

Pediatric Cardiothoracic Surgery in India

There are a number of Pediatric Cardiology Surgeries such as balloon atrial septostomy, Valvuloplasty/Angioplasty, Patent Ductus Arteriosus, Ventricular Septal Defect and Atrial Septal Defect, Tetralogy of Fallot, Total Anomalous Pulmonary Venous Return, Double Outlet Right Ventricle etc. The major ones are:

Balloon Atrial Septostomy (BAS) : This technique, also known as the Rashkind procedure used for enlarging a hole between the right atrium and the left atrium. It is often used to manage patients with transposition of the great arteries. Here the larger hole improves oxygenation of the blood.

Valvuloplasty/Angioplasty : Valvuloplasty is that process where a small balloon is inserted and inflated for stretching and opening a narrowed (stenosed) heart valve. On the other hand, angioplasty is a non-surgical process which can be used for opening blocked heart arteries.

Patent Ductus Arteriosus : This is a kind of defect in infants where vessel (the ductus arteriosus) fails to close soon after birth which results in abnormal blood flow, between the pulmonary artery and aorta, which takes the blood from the heart to the lungs and to the rest of the body. To treat it, an incision is made under the chest through which tubes are inserted to regulate the flow of blood supply.

Atrial Septal Defect (ASD) and Ventricular Septal Defect (VSD) : Both of these are congenital defects. In ASD, the wall that separates the upper heart chambers (atria) does not close completely. The surgery here involves a placement of an ASD device into the heart through catheters, which is inserted by making a tiny incision in the groin area. While in VSD, happens at the time of birth. It is explained as one or more holes in the wall that separates the right and left ventricle of the heart. In pre-natal stages, the right and left ventricles of a heart are not separate. As the fetus grows, a wall is formed for separating the two ventricles but if the wall does not form completely, a hole remains. This can be treated by inserting cardiac catheterization.

Tetralogy of Fallot (ToF) : Another congenital heart defect, it is a constellation of four abnormalities, which result in insufficient oxygen in the blood. In this case, a surgery is needed for restoring these defects which are caused, main; paid at the time when the infant is young.

High Quality World Class Pediatric Cardiac SurgeryTop Indian Hospitals 

 
The cost of heart surgery in India is perhaps the lowest in the world Some comparisons show that patients in the USA can save 90 per cent of the treatment cost by having their heart surgery in India. The cost of heart treatment in India is also very much cheaper compared with Thailand, Singapore, etc which also attract medical tourists.

Hospitals in India have a success rate of between 98 to 99% for heart surgery in India Heart surgery in India is performed by cardiac surgeons of great experience, in terms of both number of surgeries, diversity of procedures and complexity of heart conditions This experience is built on top of the outstanding academic qualifications of heart surgeons in India.

India’s hospitals have world-class cardiac catheterisation labs for diagnosis of heart diseases and performance of angiograms and angioplasties They also have state-of-the-art operation theatres that enable safe and successful heart surgery in India.”

Frequently Asked Questions - Pediatric Heart Surgery in India

Best Pediatric Heart Surgery Hospital in India

Frequently Asked Questions

Q. How common are congenital heart defects?

A. Congenital birth defects comprise the single most common category of birth defects in world. In fact, one in 100 live births is affected by some form of congenital heart defect.

Q. What are some common congenital heart defects?

A. Atrial and ventricular septal defects are holes in the heart which affect the blood supply out of the heart. Patent ductus arteriosus, a common defect in premature infants, occurs when blood flows between the aorta and the pulmonary artery through an open passageway which normally closes within a few hours of birth. Pulmonary, aortic and subaortic stenosis and coarctation of the aorta are obstructions which restrict blood supply to the rest of the body. Tetrology of Fallot has four components, a ventricular septal defect (VSD), pulmonary valve stenosis, an abnormally muscular right ventricle and the placement of the aorta directly above the VSD. Common acquired diseases include cardiomyopathy, or heart muscle abnormalities, viral myocarditis and arrhythmias.

Q. How are these defects diagnosed?

A. Pediatric cardiologists use sophisticated, non-invasive imaging technology to assess, diagnose and monitor a variety of cardiac problems in pediatric patients such as transthoracic and transesophageal echocardiography, and magnetic resonance imaging. Fetal echocardiography helps physicians to detect and monitor malformations during pregnancy which facilitates appropriate prenatal care and early intervention.

Q. What are some of the treatments?

A. Technological advances in non-surgical interventions such as catheter-based treatments for closing atrial and ventricular septal defects have enabled physicians to treat a variety of congenital heart defects early in the course of the disease and in many cases, without surgery. Other interventions include coil occlusion of patent ductus arteriosis and systemic arteries, stenting and balloon dilation of obstructed pulmonary and venous pathways, and radiofrequency ablation of arrhythmias.

Q. How is surgery performed on pediatric patients?

A. Minimally invasive surgical techniques which have been used widely in adult cardiac surgery are now being applied to infants and children with results that are comparable to standard procedures. These techniques avoid the traditional splitting of the breastbone characteristic of standard open-heart surgery by performing the surgery through a much smaller incision through the ribs, sparing patients the pain and trauma of open-chest surgery. This approach speeds recovery so that children can return to school and play much sooner, often within a week after open heart surgery.

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Affordable Pediatric Cardiac Surgery at Best Hospital in India

Pediatric Cardiac Surgery in India

Paediatric Heart Surgery in India with the Best Paediatric Heart surgeons in India is what you would want if your little one is suffering from any heart ailment. MyMedOpinion affiliate Paediatric heart surgeons in India are among the top paediatric heart specialists and offer best in paediatric heart care. Affordable Pediatric Heart Surgery in India at Best Cardiac Hospitals with Top Pediatric Cardiac Surgeons in India with MyMedOpinion.

Sometimes heart surgery in children is required for repairing defects in the heart which a child might have born with (known as congenital heart defects) and heart diseases which he gets after birth, which require surgery. Pediatric Cardiac Surgery deals with operative procedures in the newborn and unborn children and youngsters suffering from cardiac dysfunctions, structural, functional and rhythm-related issues of the heart also.

In the normal heart, electrical impulses arise from an area of specialized cells called the sinus node, which is the heart's normal pacemaker. The sinus node is located in the right atrium, the upper right chamber of the heart . After leaving the sinus node, an impulse spreads across the upper heart chambers (right and left atria) and reaches the atrioventricular (AV) node located near the center of the heart between the atria and the lower chambers, or ventricles, and then to conduction fibers that spread across the ventricles, which are the heart's main pumping chambers. 

As the impulse moves along the conduction fibers, cardiac muscle cells are stimulated and contract, producing a heartbeat.Pediatric Cardiac Surgery often deals with heart problems in children, the cause of congenital heart diseases which are common heart ailments among new born children and involves deficiencies like structural defects, congenital arrythmias and cardiomyopathies, which result in different kinds of abnormalities related to the heart. Congenital heart disease is a cause of improper growth of the heart or blood vessels before birth.

Heart Treatment in India for Major Heart Ailments in Children

The most common cardiac defects in children are the following:

• Atrial Septal Defect

• Ventricular Septal Defect

• Fallot's Tetralogy

• Valvular defects

Atrial Septal Defect

An atrial septal defect (ASD) — sometimes referred to as a hole in the heart — is a type of congenital heart defect in which there is an abnormal opening in the dividing wall between the upper filling chambers of the heart (the atria). In most cases ASDs are diagnosed and treated successfully with few or no complications. When an atrial septal defect is present, blood flows through the hole primarily from the left atrium to the right atrium.

This shunting increases the blood volume in the right atrium which means more blood flows through the lungs than would normally. If left untreated, atrial septal defect may cause problems in adulthood. These problems may include pulmonary hypertension (which is high blood pressure in the lungs), congestive heart failure(weakening of the heart muscle), atrial arrhythmias (which are abnormal rhythms or beating of the heart) and an increased risk of stroke.

Ventricular Septal Defect - VSD have a hole in the wall of their heart between their right ventricle and left ventricle (the two lower chambers, where the blood leaves the heart). Normally, blood cannot pass between the ventricles. But when there is a hole between the sides of the heart, some oxygen-rich blood leaks from the left ventricle into the right ventricle and goes back to the lungs. The hole may be small and cause no symptoms, or it may be large and cause serious problems with blood flow. If the hole is large, too much blood will be pumped to the lungs, leading to congestive heart failure. Also, the heart will have to work harder to pump blood to the body. As a result of the extra work, the heart can get bigger.

There are two main techniques to correct the disorder:

Intra-Cardiac Technique - is an open heart surgery under general anesthesia , whereby the child is attached to an external heart-lung machine. This heart lung machine performs circulatory and respiratory function during surgery. The heart is directly accessed and the defect is sutured.

Trans- Catheter Technique - this is a minimally invasive technique through which surgical instruments are passed through the catheter inserted in the femoral artery. The catheter is slowly guided up towards the point of defect to close it.

Both the procedures are quite successful. Which one is best for your child can be ascertained by the paediatric cardiac surgeon in India after the examination of the child.

Fallot's Tetralogy

Fallot was a doctor who spotted this particular type of heart defect. Tetralogy means fourfold – there are four defects found together. These four problems are: 1. Pulmonary stenosis - Pulmonary means ‘of the lungs’. Stenosis means narrowing. Pulmonary stenosis is a narrowing at or below the pulmonary valve. 2. Ventricular septal defect -Ventricular means ‘of the ventricles’ – the wall between the right and left sides of the heart . 3. Over-riding aorta -The entrance to the aorta, which should only take red (oxygenated) blood around the body, lies over the VSD, allowing the right ventricle to pump some blue blood directly into it. 4. Right ventricular hypertrophy -The right ventricle becomes thickened as it forces blood into the narrowed pulmonary artery.

The heart surgeons perform two surgeries to correct Fallot of Tetralogy heart defect in the child Blalock- Taussig's operation is a palliative procedure performed in smaller infants to increase blood flow to lungs and to allow the child to grow big enough to withstand the corrective surgery. A connection is made between right subclavian artery and pulmonary artery to pass more oxygenated blood to the latter. This relieves the cyanosis to a great extent.

The total corrective surgery is performed in children within 2 years of age. VSD is closed with a patch and the narrowed pulmonary valve is opened. The outcome of surgery is favourable and most children lead a healthy life after the surgery with minimum restrictions

Double valve repair and replacement

Valves are openings between two chambers and also between a chamber and artery which allows unidirectional flow of blood. The patency of these valves is very important for normal flow of blood. The function of mitral valve (between left atrium and left ventricle) and the aortic valve (between left ventricle and aorta) is very important. If these valves get narrowed, the amount of blood passing from left atrium to left ventricle (mitral valve) or from left ventricle to aorta (aortic valve) is drastically reduced. In this case the heart will pump blood harder to push it through the narrowed valves. But the blood will tend to go upwards back into the pulmonary vein and finally to the lungs. 

This will cause excess blood in the lungs leading to congestion. At the same time very less blood will come out into the aorta from the left ventricle which will result in reduced blood and oxygen supply to all the body parts.

Double valve repair and replacement procedure aims at correcting or replacing these both these damaged valves (aortic & mitral together) with new functional valves. This is done through the open heart surgery. The patient is put under general anaesthesia and connected to the heart lung machine. This machine takes over the pumping, circulatory, and respiratory functions of the heart and lung till the surgical procedure is going on. The valves are accessed by cutting open the rib cage and accessing the heart directly. The old valves are sliced from their attachments and new valves are put in their place. 

The new valves may be obtained from a cadaveric donor, or an animal (pig) or it may be made of a nonreactive inert material. The patient needs to be given anticoagulants or immunosuppressive to clotting of blood or rejection of organ. The prognosis of this surgery is good. It is many a time a life-saving and life extending surgery.

Why is the Procedure required?

Radio frequency catheter ablation is a procedure that is performed to correct a disturbance in heart rhythm (cardiac arrhythmia or irregular heartbeat).

It`s most often used to treat supraventricular tachyarrhythmias which are rapid, uncoordinated heartbeats starting in the heart`s upper chambers (atria) or middle region (AV node or the very beginning portion of the heart`s electrical system). In cardiology, RF ablation is used to correct:

• recurrent atrial flutter.

• atrial fibrillation (AF).

• supraventricular tachycardia (SVT).

• some types of ventricular arrhythmia.

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MyMedOpinion affiliated  Best hospitals in India provide an medical opinion from experienced surgeons and the treatment cost includes companion stay  , surgeon fee, medicines and consumables, nursing care, patient's food and airport pick up & drop etc. etc. We offer free, no obligation assistance to international patients to find world class medical treatment in India. We offer support and services to facilitate the care you require. We can help you find the best hospital in India

Send us a Medical Report to Get FREE Medical Opinion from India's Top Doctors

MyMedOpinion.com  is the hub of Surgeons and specialists for major diseases. We give you a chance to speak to our doctors and discuss your health issues directly. 

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