This approach is a kind of combination of AVR and MVR surgery. Consequently, it’s a more complex surgery and higher risk potential.

This treatment also relates to aorta valve diseases and is uses for stenosis type of that. This surgery often performs for the patient that is not a good candidate for an open heart or invasive surgery and the patient undergoes local anesthesia usually. Existing problem (stiffness or other problem) in every valve of the heart can cause these symptoms:

• Heart pain
• Feeling dizzy
• Breathing in a bad way
• Feet and ankle swelling

• You wanted to tell your cardiologist all your previous medical document and all the medicine you are taking.
• You might be wanted to stop eating the day before the surgery.
• You wanted to give written consent.
• Tell your doctor about your allergic problem.

• Allergic reaction
• Severe bleeding and need to blood transfusion
• Unusual heart beating
• Appearing infection on the tiny wound
• Not recommended for pregnant women

Bentall procedure is another surgical treatment for your main artery comes from the heart (Aorta). Its carried out by grafting aorta root and aorta valve that is diseased. An aneurysm in aorta root threat your life seriously because it may break open without treatment. The procedure: The patient undergoes general anesthesia and it may almost last 5 hours. In the beginning, diseased parts of aorta are removed and also the cardiac vessels that are in charge of pumping blood from heart to rest of body are disconnected (a machine performs flowing blood and oxygen during surgery). Finally, the graft that includes a valve replaced and is sewn between heart and aorta and cardiac arteries are connected to replaced graft. Here is artificial and natural graft valve that your doctor chooses the one is your best. Recovery time: The patient stays 1-2 days in ICU (Intensive Care Unit) and medical team checks his/her vital signs regularly. The fluid will drain his/her chest through a tube. Medical team the day after the surgery help you stand up and try to walk. But don’t rush. You’re moved toward when you feel well and stay there a few days. You may have heart palpitation until 4 weeks after the surgery that is natural and goes away. You will be wanted to do some coughing and breathing exercises to care of your chest.

Blalock-Taussig shunt is a cure for low blood flowing to the lung. Low blood flow to the lung that is called cyanotic heart and cause not sending enough oxygen to parts of the body and the baby’s skin gets slightly blue as a result. BT shunt is a closed heart sugery. In these case, cardiologist joins one part of aorta to the pulmonary artery and increases blood flow to the lung. Recently a polytetrafluoroethylene (PTFE) graft is used to make the connection. Nowadays Its used less than before because of heart surgery that is performed to cure the congenital problem for infants. But BT shunt surgery is a good option for someone with a high amount of stenosis in the pulmonary artery and result in higher oxygen flowing and diastolic blood pressure decreasing. This type of surgery also may associate with some risks and side effect such as bleeding or infection due to graft.

Cabrol is another surgical procedure related to ascending aorta problem (aneurysms) and is a newer better technology than Bentall. It’s almost grafting aorta root and the valve by synthetic material.

Coarctoplasty is a cure procedure for another common congenital heart problem. In this congenital disease, the infant has a narrow part in his/her larges artery at birth and you may not find it until adulthood and it causes hypertension. Echocardiography is one of equipment is used to recognize aorta coarctation. Coarctoplasty procedure recently includes inserting a catheter carrying a balloon into the vein on the groin or neck and transferring it to the aorta place. So the cardiologist inflates the balloon and the narrowed part get wider and make flowing blood to the heart easy. This is a newer nonsurgical approach of curing. But in the past, an invasive surgical technique during general anesthesia used to be performed. A stent implantation is also another new minimally invasive procedure to cure the narrowed artery. Stenting includes implanting a long thin tube (stent) inside the diseased artery. Coarctoplasty may associate with 1night hospitalization. Your child should have an appointment with his/her cardiologist due to some checking examinations. Risk or complication of inserting the catheter method:

• Likely breaking of the catheter that is controlled with fluoroscopy.
• Making weakness or aneurysm on the artery’s wall.

CABG is a coronary artery disease (CAD) cure and this is open-heart surgery. CAD occurs by creating plaque in the coronary artery. Plaque becoming stiff can makes kind of blockage in coronary arteries and flowing oxygen and blood to the heart will go wrong. It can also be treated with non-surgical ways. In another way, if plaque substance rupture a blood clot can take place on it and create large blood clots. Clots narrow the coronary arteries and cause often a heart attack. Before the surgery:

• You are wanted to have some examination to prepare for the operation; such as coronary angiography, chest X-Ray, blood test, catheterization and etc.
• You are likely to be wanted to stop smoking.
• You should talk with your doctor through medical team and they tell you about your eating and taking medicine before the surgery.

• You will be moved to ICU for 1 or 2 days and under checking vital sign regularly.
• Then you go to the normal rooms of the hospital and stay 3 to 5 days there.
• you are wanted to change your lifestyle to a healthy way and take medicine to prevent blockage of grafted vein again.

Several years after CABG surgery gust a few patients may experience re-blockage of coronary arteries or grafted coronary arteries. It occurs especially in elderlies. So you need to undergo redo CABG. In redo CABG the cardiologist faces with a more challenging way.

Sometime, valve replacement may be required in patients undergo coronary artery bypass grafting. This combination is a good choice for people who are suffering from severe heart disease, although it’s a little complex.

On-pump CABG associated with cardiopulmonary bypass but off-pump doesn’t. The heart continues its work during off-pump CABG and delivers blood to the rest of the body. Cardiologists used to have a debate on the advantages and disadvantages of them till now. Off-pump CABG is newer. It’s not required to apply the cardiopulmonary bypass machine. It's known that off-pump CABG has low post-operative risks, although the on-pump is a better way of supplying blood for parts of the body during the surgery. Performing an off-pump CABG operation is possible for a kind of experienced cardiologist. So choose of method depends on your cardiologist. Before off-pump CABG surgery:

• Get important cares and details talking to your doctor in advance.
• You maybe wanted to stop smoking and taking blood-thinning or other medicine before the surgery.
• Someone may shave your skin surrounding the intended area.
• You’re wanted to fast the night before the surgery.
• You will have some examination before the procedure.

• The higher amount of bleeding
• You may need another surgery to supply flowing of blood to the heart
Infection
• Uneven heart beating

EPS is a kind of surgical examination that is performed for a patient with a heart problem sometimes. EP study can determine lots of information about your heart condition and lasts about 1-4 hours. You may be given sedative or undergo general anesthesia. This study is a common choice in irregular heart beating condition and sometime before serious heart surgeries. The procedure of study: arrhythmia The starting point is the same as angioplasty and a thin tube will be inserted into the vessel and a catheter will be guided through the tube into the heart. The vessel is on your groin or neck. Electrodes are connected at the end of the catheter and record the heart’s electrical activity. This electrode can change the heart beating to a faster or slower state and the heart response will be recorded. So by placing the catheter in various area of the heart likely extra electrical signals and the causes of them can be determined. EP study is a preliminary step of cardiac ablation to choose the appropriate area and cure arrhythmia by giving cold or heat energy and making scar tissue that stops irregular heart electrical signals. After the surgery:

• You've moved to the recovery room and it lasts 1-2 hours.
• The medical team will check and measure your vital signs.
• The patient can go home the same day of the surgery.
• Another person should drive you home.
• After the surgery, an appointment with your doctor is planned to talk about the chosen treatment procedure, although the surgical treatment may be performed at the same time of EP study.

Radiofrequency ablation is one of the treatment ways of irregular heart beating or heart arrhythmia that can be performed as the same time of EP study and your doctor let you know that you will undergo EPS or RFA or both. It lasts for 1-2 hours. You may be given sedative medicine or even may undergo general anesthesia. The anesthetization way depends on the kind of heart problem. The procedure: The starting point is the same as EP study and a thin tube will be inserted into the vessel and one or more catheter will be guided through the tube into the heart. The vessel is on your groin or neck. The end of the catheter by producing Radio Frequency (RF) energy ablate diseased heart cells or tissues that make irregular electrical signals. So the heart arrhythmia will be cured. If you are awake and feel pain, you should tell your doctor. After the surgery:

• You've moved to the recovery room and the medical team monitors your vital signs.
• You need to take your first step in getting help.
• You have to rest on your bed for several hours.
• Patients may go home after this surgery or stay overnight.
• Feeling a strange heartbeat in the first 2 days is natural and will go away.

Carotid arteries are the artery in charge of transferring blood from the heart to the brain. Occurring a narrowed part or blockage in this artery is one other cardiac problem that prevents the following blood to the brain and it may cause a stroke. A narrowed carotid artery may not have any symptom but a carotid ultrasound can help to diagnosis it. So surgery is required. Carotid angioplasty and carotid stenting are the other choices. The procedure of operation: In carotid endarterectomy, first, the patient undergoes general or local anesthesia. A small incision is made on his/her neck to reach the carotid artery. Next, the surgeon opens the carotid artery and removes the atherosclerotic plaques. Then he/she stitches the artery. The surgical team controls the patient’s vital sign during the operation. After the surgery:

There is a risk of narrowing the carotid arteries again due to high blood cholesterol.
• You've wanted to take special medicine to avoid occurring new blockage in carotid arteries.
• Eating may be difficult for a few days due to your hurt neck.
• You will be hospitalized for 1-2 days.
• You may experience temporary numbness on your face.
• The patient has a few risks of infection or bleeding.
• Risks are a little more in women and elderlies.

Fontan is a treating approach for several congenital heart problems, such as pulmonary atresia, hypoplastic left heart syndrome (HLHS), tricuspid atresia and etc. It can be performed for children between 1.5-3 years old and it’s open-heart surgery. Arteries are long thin tubes that transfer blood from the heart to the rest of the body and veins are some other long tin tubes that transfer it from all parts of body to the heart. There is a congenital disorder which in venous blood (blue) and arterial blood (red) is mixed. During Fontan procedure, some change occurs in your child’s heart that causes transferring venous blood to the pulmonary artery and then to lung preventing entrancing venous blood to the ventricle. The procedure is making a connection between the right atrium and the pulmonary artery that decreases the chance of arrhythmia and thrombosis. Fontan procedure cause the blood in low oxygen level first moves to lung and get some oxygen and then the blood in high oxygen level transfers to heart and enter arteries. So mixing of low and high oxygen level blood is prevented. The procedure: The surgeon grafts a tube named conduit to connect inferior vena cava (the large blood that retunes blood from lower parts of the body to the heat) directly to the pulmonary artery. The cardiologist also makes an opening on the conduit to allow following an amount of blood to the right atrium and it makes lung adapt to extra blood following. After the surgery:

• Your child will be hospitalized for 1-2 weeks and medical team control all health factor daily.
• If the procedure doesn’t work out heart transplantation is required.

Norwood open heart surgery is another approach to cure hypoplastic left heart syndrome (HLHS. HLHS is a serious congenital disorder and can kill your baby. Totally the normal heart beating is a consequence of the below process:

• Right parts of the heart send low oxygen level to the pulmonary artery and then to the lung.
• The low oxygen level blood will get oxygen-rich in the lung.
• The oxygen-rich blood from the lung will be delivered to the left part of the heart.
• Left parts of the heart are in charge of sending oxygen-rich blood to all parts of the body.

• Existing abnormal tight mitral valve.
• Left ventricle with a smaller size than the typical form.
• Existing abnormal tight or closed aorta valve.
• Tight aorta artery.
• Sometimes existing atrium septum defect (ASD).

• Out of energy
• Purple or blue lips and skin
• Having problem in breathing and eating.
• Coldness of body

• Loosening atrium septum defects to allow passing oxygen-rich blood through the right ventricle.
• Making an artificial tube between the right ventricle and pulmonary artery.
• Making a looser aorta to sending oxygen-rich blood from the right ventricle to parts of the body.

• Your baby will be hospitalized about 20-30 days to recover and undergoes monitoring and medication.
• Norwood surgery will be completed by another surgery called Glenn and it is performed 4-6 months age.

In Glenn surgery, the cardiologist removed the artificial tube carrying blood from the right ventricle to the pulmonary artery and makes a path between the main vein and pulmonary artery.

Another approach to cure arrhythmias in ventricles is ICD or implanting a device in your chest to help the heart have a normal heart beating. The Defibrillator is a small device that is placed in your body during kind of angiography procedure and it takes 1-2 hours. The defibrillator’s battery is almost charged about 7 years but generally, the time that battery is charged depends on defibrillator’s activity. Defibrillator starts sending electrical pulses to the heart at the same moment that recognizes an irregularity in heart beating. Actually, a defibrillator is in charge of shocking automatically the heart at the cardiac arrest and some situation like that. When the defibrillator works you may feel pain just a second and it ends after that. Usages are in following patient:

• Who had a previous heart attack or heart arrest
• Someone with long QT syndrome.
• Who has congenital irregular heart beating.
• Who has some problem with his/her heart muscle.

• You should make an appointment with your doctor regularly for monitoring the defibrillator’s work.
• You maybe wanted to take some medicine to decrease the number of defibrillator’s shock.

The pacemaker is a device that placed below the collarbone and under the skin and in a kind of electrical connection with the patient’s heart and helps to regularize his/her heart beating. The connection between this small electrical device and your heart occurs with one or more leads (wires) that reach atria or ventricles or both. Double chamber pacemaker has 2 leads in both right chambers of the heart and single chamber pacemaker is in charge of ventricular rhythm regularization.

Patent ductus arteriosus is another congenital defect in heart structure that exists at birth and occur complication for your baby. Generally, PDA means existing an abnormal connection between pulmonary artery and aorta that causes entering oxygen-rich blood of aorta to the pulmonary artery. It makes the heart to work more. The connection that called ductus arteriosus and normally exist before the birth typically will be closed at first days of birth but if it stays longer, it ruins the whole process of heart’s working. Sometimes it caused by birthing before the normal time. The symptoms:

• Breathlessness
• Hypertension in lung
PDA treatment approach is surgical but sometimes it can be closed under the nonsurgical angiogram process. The closure procedure: In the angiogram procedure, a device or plug goes through the catheter to PDA location in the heart and placed there. In another approach, the surgeon makes an incision on the left chest and the defect will be closed under the kind of suturing. And in adulthood, a surgical patch is applied. Notice: The PDA in babies may be small and doctors can cure it by medication but at first weeks of birth. After PDA closure: Your child doesn’t require an appointment and examination periodically and taking medicine.

Tetralogy of Fallot is a very complex, rare and congenital heart problem that exists at the birth and include four heart disorder together:

• Existing ventricular septum defect (VSD): VSD is an abnormal opening on the divider wall of the right and left ventricles. Existing VSD hole cause flowing oxygen-rich blood to the right ventricle and mixing with low-level oxygen in it.
• Obstruction of the pulmonary artery: pulmonary artery is in charge of transferring of blood from right ventricle to lung and this obstruction will limit this action. So your child’s heart should work more to supply the required blood of the lung.
• The abnormal thickness of the right ventricular’ wall and shrinking of the right ventricle that is the result of working hard of the right ventricle to supply required blood of lung through the narrowed pulmonary artery.
• Placing the opening of the aorta over VSD that cause flowing low-level oxygen from the right ventricle to the aorta and then to the rest of the body and prevent entering it to the pulmonary artery. Normally, the end of the aorta should be placed in the left ventricle.

• the purple or blue color in child’s skin, lips or nails
• Bluish lips or skin may happen during crying or feeding.
• Heart murmur
• Shortness of breath
• Unconsciousness
• Lethargy
• Having no reaction to sounds and touch
• Crying a lot
• Not growing and gaining weight normally

• Echocardiography
• Electrocardiogram
• Chest X-Ray
• Pulse Oximetry
• Cardiac Catheterization

Some congenital heart disorder can be corrected by repairing or replacing one or more valve or blood path (conduit). And these artificial valves or conduit takes long-term years. Inserted conduit after a long time should be replaced due to likely blockage or narrowing over time.

An arterial switch operation is a curative approach for another congenital heart problem that your baby may be born with it. This serious complication that is a transposition of the great arteries (TGA) means that two main arteries (pulmonary and aorta) change their place (aorta is placed on the pulmonary and in left chambers of the heart) and do the other’s task. The two right chambers of the heart are in charge of pumping oxygen-poor blood to the lung through pulmonary that normally is placed there. Two right chambers are in charge of pumping oxygen-rich blood that has come from lung to the rest of the body. So existing TGA cause entering oxygen-poor blood to the aorta and then reaching the parts of the child’s body. Also, oxygen-rich blood from the lung that exists in the left parts of the heart flows to the pulmonary and back to the lung. The surgical treatment procedure: This surgery is performed in the first weeks of birth in an open heart condition. In this operation pulmonary and aorta is switched and is placed in the correct chamber. After the surgery:

• Your child may require taking medicine.
• Your child may require to be visited regularly by a pediatric cardiologist.

Two types of Atrioventricular defect exist: Partial atrioventricular defect: there is an abnormal opening between the left and right atriums and mitral valve (the valve between two left chambers of the heart) doesn’t work properly. Complete atrioventricular defect: there is an abnormal opening in the center of four chambers of the heart and cause leaking blood to lower chambers and it makes the heart work more and more. So the heart muscle grows abnormally. This serious hole makes oxygen-rich and oxygen-poor blood mix too. AV canal can’t close over time and your child requires open-heart surgery. In serious symptom, your child’s cardiologist decides to perform the surgery in the first months of birth. The procedure of surgery: The likely ASD or VSD will be closed by a kind of sewing or using the patch. The likely large hole in the center of four chambers also will be repaired and the surgeon changes it to normal valves that should exist like a mitral valve. After the surgery:

• A few ones may experience abnormal heart beating and require implanting pacemaker.
• Your child may have some problem with exercising.

The name of this heart problem can almost describe the disorder. There is some fault about the vessels carrying fortified blood by oxygen to the heart (pulmonary vein). Unfortunately, in this congenital complex heart problem, the pulmonary vein doesn’t reach the left chambers of heart and the pulmonary vein’s tip is placed in the right atrium. Also, the patient has an atrium septum defect (ASD). And an obstruction in pulmonary may also exist. Normal procedure of heart working: The oxygen-rich blood from the lung comes back to the heart and the pulmonary vein carries that to the left parts of heart and the aorta delivers it to the body. Right parts of heart are in charge of keeping oxygen-poor blood and transferring it to the lung.
The heart’s procedure in TAPVC: In this condition, pulmonary vein transfers the oxygen-rich blood to the right atrium. In right atrium oxygen-rich blood mix with oxygen-poor blood. So this blood leaks through the ASD to the left atrium and then reach the left ventricle. Normally aorta’s tip is placed in the left ventricle and deliver low-oxygen-level t rest of body. Moreover, the required amount of oxygen doesn’t reach to the child’s body. On the other hand, some fortified blood reaches the right ventricle and the pulmonary artery sends it to the lung again. The cardiologist cures this problem in an open heart surgery that includes kind of sewing of the ASD and placing the pulmonary vein’s tip in the correct chamber (the left atrium). After the surgery:

• Your child may be wanted to take antibiotics before some type of surgery due to the risk of inflammation in the heart.
• Your child may have some problem with exercise in the future and he/she maybe wanted to reduce it.