Surgical Procedures for Congenital Heart Disease in Children

1183 words | 4 page(s)


The purpose of this annotated bibliography is to examine the questions, “What are some surgical procedures for congenital heart disease (CHD) in children? What were the first efforts, and what are the current choices?” This articles were located using library databases and conducting keyword searches using the words and phrases surgical procedures, congenital heart disease, and children, as well as the date of publication being limited to 2010-current.

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Annotated Bibliography
Gonzales, I., Kenny, D., Slyder, S., & Hijazi, Z. (2013). Medium and long-term outcomes after
bilateral pulmonary artery stenting in children and adults with congenital heart disease. Pediatric Cardiology, 34, 179-184.

The purpose of this study was to examine concomitant bilateral pulmonary artery (PA) stenting in pediatric and adult patients and to determine what the medium and long-term outcomes were following the procedure. The authors retrospectively reviewed complete procedural and follow-up data from a ten-year period covering October 2001 to May 2012. They focused on patients who had had percutaneous PA stenting performed by a single operator. Of the 26 patients examined for this study, 23 were younger than 18 years of age; a combined total of 62 stents were placed. Follow-up data was available for 21 of the 26 original patients; two patients died in the intervening years, one as a result of transplant complications, the other as a result of sickle cell complications. The results show that many of the patients had to have stenting conducted again after the initial stenting procedure; a few had to have balloon angioplasties. Ultimately, the authors found that, in keeping with previous literature, that “addressing both PA branches during the same procedure is feasible and leads to significant reduction in the RV pressures and pressure gradients across the PAs” (p. 183). The authors conclude that the procedure is safe and effective but that reintervention is common.

Since the majority of the patient data studied for this article was for individuals younger than 18 years old, this article can provide excellent information regarding surgical procedures for treating CHD in children. Bilateral PA stenting is an effective, safe, and appropriate intervention for CHD in children, though reintervention may likely be required following the initial procedure.

Kalfa, D., & Bacha, E., (2013). New technologies for surgery of the congenital cardiac defect.
Rambam Maimonides Medical Journal, 4(3), 1-14.
The authors of this article highlight and review new technologies associated with surgery for CHD and congenital cardiac defect (CCD). They focus on tissue patches, highlighting the porcine-based CorMatrix®; new devices like the Melody® valve and tissue-engineered valve conduits; and emerging technologies like antenatal corrective cardiac surgery or robotically assisted congenital cardiac surgical procedures. There are many benefits associated with CorMatrix® but the authors state that not enough is known about the long-term effects or performance of the patches is available. The Melody® valve, which is bovine-based, has been shown to “reduce the number of the number of multiple open heart operations in children and young adults with congenital heart disease, and may improve their life expectancy
and life quality” (p. 3). The tissue-engineered valve conduits emerged in response to the limitations of current valve options, especially for children who would require multiple operations as a result of growth, which render current options unviable in the long-term. The antennal procedures do not appear appropriate for children, but robot-assisted heart surgeries have been performed on children, but the authors do not report on the success of those surgeries. The authors conclude that these emerging options for treating CHD/CCD are promising but require more study.

Of pertinence to this particular bibliography, this article does examine the applications of several of these technologies for children. They appear to promising for the treatment of children, especially in terms of reducing surgeries that are necessary as the children grow and develop.

Karaci, A.R., Aydemir, N.A., Harmandar, B., Sasmazel, A., Saritas, T., Tuncel, Z., & Yekeler, I.
(2012). Surgical treatment of infective valve endocarditis in children with congenital heart disease. Journal of Cardiac Surgery, 27, 93-98.
The purpose of this article was to examine valvular endocarditis in children with CHD and its treatment via surgery. The authors studied seven children who had previously diagnosed congenital heart defects who had undergone surgical repair for infective valve endocarditis. All of the patients had vegetations removed and valves repaired. There were no operative mortality and morbidity, and no complications were identified. The microorganism responsible for infection could only be identified in five of the cases, and of those five three were Staphylococcus aureus. The authors noted that in their case studies, the patients had not yet had their defects repaired, which “emphasizes the potential threat of this organism in patients with unrepaired congenital heart defects” (p. 97). The authors determined, based on their review of the cases and their experiences, that “mitral and tricuspid valve repairs are safe in children with infective endocarditis” (p. 98).

The relevance of this article to this bibliography is its focus on children with CHD and surgical repair related to CHD. Though this article does not focus on the repair of the primary CHD defects, it does focus on a related aspect of the CHD. This article also highlights the importance of monitoring children with CHD to avoid complications that can be easily avoided.

Tilahun, B., & Tefera, E. (2013). Transient left ventricular systolic dysfunction following
surgical closure of large patent ductus arteriosus among children and adolescents operated at the cardiac centre, Ethiopia. Journal of Cardiothoracic Surgery, 8(139), 1-5.

This study focuses on patent ductus arteriosus (PDA), one of the most common congenital heart diseases which requires repair shortly after birth. This study is geographically located in Ethiopia. The authors related that cases of post-operative left ventricular systolic dysfunction (POLVD) following repair of PDA had been reported in the Highland. The authors studied 36 children who had undergone PDA; they observed the children for a median period of 1-2 years. The authors determined that those patients who had had large-sized PDA had a high occurrence of POLVD, as well as those who were older when they had the procedure. The authors recommended systematic and regular follow-up for the children post-op.

The relevance of this article to this bibliography is clear: it focuses on children who undergo repair for PDA, a common CHD defect. Not only does it highlight the fact that PDA repair is a safe and effective procedure, it also highlights a common complication associated with the repair and its incidence of success.

Based on the studies examined here, some of the current procedures associated with CHD include valve repair, duct repair, and stenting. The literature suggests that many of these procedures for children evolved as the procedures for adults developed. However, children present a special challenge in terms of the endurance of the repairs: children are still growing and developing, meaning that reintervention is inevitable, since the repairs won’t last.

Because of this special challenge, emerging technologies are even more important. Patches, new types of valves, and robot-assisted procedures have been developed, some in response to the special challenge that children present. The developments of these options don’t quite demonstrate the best options available, since some of the procedures haven’t been studied long-term. But they do represent improvements to current practices.

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