Cardiology

Cardiology treatments:



Closed heart surgery

Some heart problem now and with recent technology don’t need to access inside of the heart completely. Being close to a heart surgery relates directly to using the heart-lung bypass machine. In open-heart surgery that cardiologist access to heart directly and start some change in that your heart should be empty of blood and stopped during the period of surgery. All past heart surgeries were in an open way. Closed heart surgeries often relate to aorta vessel. Closed heart surgeries are performed using some tiny incision on the right part of your chest and among ribs mostly. Types of possible closed heart surgery: Treat diseased pulmonary arteries division of a vascular ring aortic coarctation cure and etc. Shorter recovery time and lower irritation and pain are some of the closed heart’s Properties.

Angiography (Including Non-Ionic Contrast)

The physicians advise their patients to perform angiogram procedure when symptoms like chest pain or heart attack make worry. Angiography procedure's goal is determining blockages in the coronary arteries expect other cardiovascular-related illnesses. It can locate narrowing or blockages of all arteries. Patients with aortic stenosis or abnormal heart stress test may also be required to perform Angiography. This procedure lasts 30 to 120 minutes and you’re not required to be hospitalized. During Angiogram patients are awake apart from children that may require general anesthesia. The procedure: First specialist makes a tiny cut in your groin or arm to gain an artery. Next one slim long soft tube is guided to the Intended area from an artery. Then something like dye is inserted through that tube and during it's flowing through artery some x-ray is taken. Opening of likely blockages or narrowing is possible in this step that is called angioplasty surgery. The small cut that had occurred doesn’t need Stitch. Drinking water is recommended to make dye released through your urine. Just avoid lifting heavy things first days.

Angioplasty

Fortunately, angioplasty is not an emergency and you can make a plan for doing it. Angioplasty surgery is almost a simple surgery and the procedure is almost like angiography. Sometime, the cardiologist will perform angioplasty following the angiography and at the same time. Actually when he/she find the blockage or narrowing. Before the surgery: You shouldn’t eat or drink 4 to 6 hours Ask your cardiologist to know which medicine you are allowed to take You can usually take your daily medicine except for anticoagulants like warfarin You shouldn’t eat or drink 4 to 6 hours During the surgery: Angioplasty last 30 to 120 minutes usually. Starting the operation is the same as angiography and it is done in local anesthesia condition too. The cardiologist makes a small incision on the patient’s wrist or groin or arm which doesn’t need stitch at the end of the operation. Then a tiny flexible tube is inserted into the artery and keep the artery open to do the following operation. The catheter is inserted into the tube and from the catheter, the cardiologist sent a thin wire until gaining blocked area. In this step, the balloon was inserted into the catheter with that wire the cardiologist start inflating the balloon and it almost continues 20 to 30 seconds. It may occur a few extra heartbeat and pain but don’t worry about that. The inflated balloon makes pressure on accumulated fat on the artery wall and destroys them. This action may be repeated. So the blockage will be open. The balloon is deflated and will be taken out. Sometimes one stent is inserted to the artery over balloon and it remains there and prevents blocking of that again. After the surgery:

  • Take care of your wound.
  • You may feel a few pain in your chest. In severe pain taking paracetamol is recommended.
  • Likely bruise around the incision isn’t serious and will heal soon.
  • It doesn’t have difficult recovery time and the patient can go to the hotel after the surgery, but in some cases, he/she is hospitalized one night.
  • You should take more care to have a healthier diet and lifestyle like some other coronary surgery.

Artial Septa Defect (ASD) Closure Repair

ASD disorder relates to existing a big deep opening on atrial septum wall. It is so serious problem in your heart and caused by genetic factor. ASD patients have more chance to experience stroke and heart problem. The heart has 4 separated areas. Artial septum wall is between 2 upper ones. Existing of an opening on atrial septum wall cause returning back excess blood to the right atria and finally to the lung. So right atria and right ventricle get bigger and blood pressure in the pulmonary artery is increased. It’s noticeable that small hole on atrial septum wall may exist naturally at birth and it may be closed on its own but big ASDs are very dangerous and have to be closed through a treatment. It’s better to perform this surgery in childhood preventing heart problem in adulthood. The symptoms of ASD:

  • Shortness of breath
  • Making fluid in your legs
  • Heart murmur
  • Making fluid and blood in the lung
  • Tiredness and Tiring
The procedure of the surgery: In surgical treatment, cardiologist closes the ASD by sewing but in bigger openings that suture doesn’t work out a graft is used. The graft can be a portion of the pericardium or synthetic substances. This surgery is started by a 4-6 (cm) incision on your right side of the chest. There is another not totally surgical treatment. It is performed by inserting one closure device through an artery from groin like angiogram proses. After the surgery:
  • Some medicine should be taken a few months after surgery to prevent coagulation of blood and infection.
  • If you faint or have palpitations, you may need medication therapy.
  • If the patient were old, he/she would require diuretics and medicine to help the heart to pump blood.
  • This operation doesn’t restrict you from doing any normal activity and there are just a few Restrictions for the patient with high blood pressure in pulmonary vessels.

ASD Heart Port Surgery

Heart port surgery is another minimally invasive surgery to cure ASD. It is performed to cure some cardiac illness, especially for ASD disorder and valve replacement. Before the surgery:

  • Your doctor prevents you from smoking usually before the surgery.
  • You should probably stop taking blood-thinning medicines.
  • The cardiologist should make sure of general health inpatient, so he/she has performed some examination before the surgery.
  • The procedure: Heart port ‘s not a full open-heart surgery. In the beginning, the patient undergoes general anesthesia. First of all, the cardiologist makes an incision on your neck and insert a tube into a vessel reaches to the heart. Temporary stopping heart function is performed by inserting some medicine through the tube is inserted into that vessel. A machine in charge of carrying and delivering the oxygen to parts of the body instead of your heart is joined and your natural heart beating is stopped temporarily. Then some tiny ports are created among right ribs and the cardiologist inserts his/her surgical instrument and defect closure will be performed. Finally, the patient gets stitches and will be sent to ICU. After the surgery:
    • The patient will have an easier and quicker recovery time than full open-heart surgery
    • In ICU his/her vital sign will be controlled and when the vital sign is normal and stable the patient will be sent to normal room of the hospital.
    • The patient needs to be hospitalized just 1 or 2 days.
    • When the patient is released from hospital he/she will get a prescription.
    • If you had redness or inflammation in incision areas or you had fever tell your doctor immediately.
Ventricular septal defect (VSD) closure surgery

Ventricular septal defect or VSD cause by existing a defect or a kind of hole on the wall between two lower parts of the heart (interventricular septum); left ventricle and right ventricle. It’s a congenital heart disorder that exists at birth. So blood starts leaking from left part to the right one. Consequently, the right ventricle should discharge more flowing of blood to the lung and works more. Existing of this lake can occur severe heart complication, such as pulmonary disorders (Eisenmenger syndrome), endocarditis, infections, and even death. Moreover, infants with this complication have to undergo surgical treatment. The procedure of the surgery: In this surgery, the infant’s heart will be stopped and cardiopulmonary bypass machine that simulates heart’s work will be used and supplies required oxygen. This procedure makes the heart empty of blood and it makes the closure process possible. VSD is repaired by suturing artificial patch. Natural growing of heart tissue over time (about one year) cause kind of covering the patch. After the surgery:

  • You’re wanted to take antibiotics 6 months after the heart surgery and before another surgical procedure due to likely infection an artificial part.
  • VSD closure works out well mostly and your infant doesn’t show any symptom ever.
  • After a few weeks, the patient will come back to a normal life.
  • You can communicate with your doctor after the surgery and ask any unclear things.

Aortic Valve Replacement (AVR surgery):

The aortic valve is in charge of receiving blood from the heart (left ventricle) and transferring it to the aorta artery. Aorta artery carries blood to all parts of the body. So existing every problem in this valve can cause serious heart complications and illness. The problem means that the aorta valve’s closing or opening doesn’t work well. It can exist at your birth or occurs during a lifetime. For example, the open valve in the relaxing time of the left ventricle makes blood return back to the left ventricle. Also, aorta valve disorder can cause a problem in pumping blood to your parts of the body. The symptom:

  • Tiredness
  • Chest pain
  • Irregular heart beating
  • Shortness of breast
  • loss of consciousness
  • Before the surgery: You should connect to your specialist and ask about your allowed medication before the surgery. Ask your doctor about something that you can eat the day before the surgery. The procedure: This surgery takes 2-4 hours and you undergo general anesthesia. The process can be performed in an open heart (in repairing the aorta valve) or minimally invasive (in replacing aorta valve) condition. In an open heart way, the first cardiologist occurs a 15 to 20 (cm) cut on the patient’s chest and inserts his/her instrument through the breastbone. He/she joins an artificial heart-lung machine to your heart to simulates your heart’s blood pumping and prevent the natural way of it. And the final step is repairing the damaged valve. In minimally invasive surgery cardiologist creates just some tiny incision on the chest or on your leg and insert a catheter and guide the replacement aortic valve. The replaced valve can be from an artificial or natural substance. After the surgery: You will be sent to ICU and stay 1 night there. Then you will go to normal room of the hospital for a few days. The medical team examines your vital signs regularly. You will be wanted to take care of likely infection and taking medicine. Generally, recovery time depends on the patient but you’re wanted to walk and increase your activity during your hospitalization to decrease the recovery time. You are wanted to stop driving and carrying heavy things for a few weeks. Risks that you may experience are the infection, blood clotting, bleeding, irregular heart beating.

Mitral Valve Repair or Replacement (MVR surgery)

Heart divides into 4 separate part and Mitral valve is between the left ventricle and left atrium (2 left part of those). Some disorders can affect the mitral valve in the same way as the aorta valve. These disorders generally have two types: mitral valve stenosis: This problem involves kind of blockage in this valve that prevents flowing well of blood through it. mitral valve regurgitation: This complication occurs when a blood leak left atrium during its fallowing to the left ventricle. It causes not to complete closing of the valve. Mitral valve diseases may not have any symptom and in severe cases, you need surgical treatment. MVR also can be minimally invasive surgery or open heart and your doctor can choose to replace or repair the mitral valve. Before the surgery: You should have a series of examinations to select surgical procedures. The procedure of the surgery, recovery time and the side effect is the same as AVR surgery.

Double valve replacement (DVR)

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

Balloon aortic valvuloplasty (BAV)

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
Before the surgery:
  • 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.
The procedure: The start point is the same as angioplasty operation and your cardiologist inserts a tiny catheter into a vein in your groin and continues until the heart valve (aortic valve). He/she sent an especial balloon through it to the stenotic valve. When the balloon reaches the intended point the cardiologist will inflate the balloon and it causes the opening of the valve. Then the cardiologist deflates the balloon and removes it and the catheter. After the surgery, you should rest on the hospital bed for several hours and you will be hospitalized the night normally but your stay at hospital depends on your condition after the operation. Potential side effect:
  • 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

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 or BT shunt

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 surgery

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

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.

Coronary Artery Bypass Grafting (CABG)

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.
The procedure of the surgery: Cardiologist joins or grafts a healthy wide vein from your body to diseased coronary artery. The healthy vein bypass diseased section of coronary artery actually. In one Session surgery, the cardiologist can bypass several diseased coronary arteries. This procedure decreases the risk of heart attack significantly. After 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.

Redo CABG

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.

CABG+AVR/MVR

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 versus Off-Pump Coronary-Artery Bypass Surgery

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 procedure: At first, you will be given anesthesia and you will undergo general anesthesia and it lasts 3-4 hours. Next, the surgeon makes an incision to reach a healthy vein and then makes some small incision on your chest (in minimally invasive surgeries) and your heat will not be stopped. The healthy vein that has been removed will be joined to the aorta in one end and will be joined to blockage part of the diseased artery in another end and bypasses the blockage. After the surgery, you may be unconscious for several hours. Your stitches will be removed after 6 to 7 days. Avoid picking heavy thing up and driving and something like these for several weeks at least. Risks of off-pump CABG:
  • The higher amount of bleeding
  • You may need another surgery to supply flowing of blood to the heart
  • Infection
  • Uneven heart beating

Electrophysiology study or EPS

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 or RFA

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 endarterectomy

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 operation

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 procedure

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.
HLHS is:
  • 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).
So in HLHS the left parts of the heart can’t work in order and sent oxygen-rich blood to rest of body. The symptoms:
  • Out of energy
  • Purple or blue lips and skin
  • Having problem in breathing and eating.
  • Coldness of body
Norwood surgery is the first step of the treatment approach. It is performed at first days of birth and reduces the risk of the sudden death of your baby. The procedure includes below actions:
  • 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.
After Norwood surgery:
  • 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.

Glenn procedure

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.

ICD (implantable Cardioverter-Defibrillator)

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.
Before ICD: You’re wanted to have some examination, such as Electrocardiography (ECG) and Holter monitoring, event recorder and EP study The procedure of implanting: Wires came out from the defibrillator is inserted in your vein and they will be guided to the heart and the monitoring device is placed below your collarbone and under the skin. You need one day lying without move to help defibrillator settle in well. After implanting defibrillator:
  • 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.

Pacemaker Implant Double/single Chamber

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 (PDA) closure

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 Surgery

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.
This four-fault generally makes a situation that enough oxygen-poor doesn’t flow to the lung. Moreover, oxygen-poor blood reaches parts of baby’s body. The symptoms of Tetralogy of Fallot:
  • 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
You and your child doctor notices these symptoms during the first week of birth. Diagnostic exams:
  • Echocardiography
  • Electrocardiogram
  • Chest X-Ray
  • Pulse Oximetry
  • Cardiac Catheterization
The procedure of treatment: This complex congenital heart problem requires open-heart surgery that should be performed during the first weeks of birth. In this surgery the pediatric surgeon cure four defects of the heart. He/she changes the Diameter of the pulmonary artery and removes the blockage of it. He/she closes the VSD during a kind of suturing or placing the patch. Consequently, the two other defects will be corrected. So all oxygen-poor blood flow through the pulmonary artery and reach the lung and just oxygen-rich blood flow through the aorta and reach parts of the body after the surgery. In a few cases, that baby is not medically prepared for this difficult complex surgery, the cardiologist may decide to do a temporary surgeon in infancy and perform other actions of the surgery later when your child is in a good medical and physical condition. Another temporary surgery is placing an artificial tube between the pulmonary artery and aorta. After the surgery, the medical team tells you all to care about your baby.

Conduit repair or replacement

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.

Arterial switch operation (ASO)

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.

Atrioventricular canal (AV canal) repair

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.

Total Anomalous Pulmonary Venous Connection (TAPVC)

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.

For more information, please feel free to contact us.
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