TreatmentChildren who have minor heart defect may not need treatment and most of them are healthy and active. However they are at risk of bacterial infection involving the heart. Dental extraction or some surgical procedures may introduce bacteria to the blood stream therefore patients with congenital heart defects undergoing those procedures are advised to have a dose of antibiotic beforehand. Significant heart lesions can be treated by the following methods:(A) Medical treatment: Medications are useful in controlling heart failure symptoms, maintaining the blood oxygen level and prevention of spells in certain heart lesions. But medications at the best are only able to improve symptoms only; there is no effect on the structural abnormalities. Surgical correction or interventional cardiac catheterisation is required to repair the heart lesion to normal or near normal. (B) Interventional cardiac catheterisation To perform a cardiac operation the heart must be exposed by a large incision on the chest. A large wound will increase the risk of infection and bleeding. It will be more painful and the recovery will be longer. Children undergoing cardiac operation will stay in the hospital for 5-7 days after the procedure. Interventional cardiac catheterisation is developed as an alternative to surgical treatment to correct heart lesions by transcatheter methods. The procedure is performed by introducing specially designed catheters into the heart or blood vessels. Devices to close holes in the heart or to occlude abnormal vessels are then deployed via these catheters. Some catheters have a inflatable balloon incorporated to the tips. Inflation of the balloon by fluid will enlarge narrow heart valves and blood vessels. By these means a lot heart lesions can be managed without surgery. As the catheter is advanced into the heart through blood vessels in the groin only tiny incision is required. Therefore the recovery is much shorter than surgical operation. Children treated by interventional cardiac catheterisation can be discharged home the next day after the procedure. (C) Surgical treatment: The idea of surgical correction is to reverse the structural abnormalities to normal anatomy, for example to close a hole in the heart, to enlarge narrowed segment of blood vessel or narrowed heart valves, to replace non-functional heart valves with artificial valves etc. Sometimes the surgery involves adding in new structures, e.g. shunt operation to increase blood flow to the lungs in Tetralogy of Fallot. The procedure is to implant a small tube between a branch of the aorta and a branch of the pulmonary artery, to direct more blood to the lungs from the aorta.
In some cardiac operations the heart beat must be stopped before the surgeons can cut open the heart chambers to repair the lesions. In these situation the child will be put on a heart-lung machine that take over the child's circulation and breathing. This is referred to as 'open heart surgery'.
Medications, surgical corrections and interventional cardiac catheterisation are complimentary to each other. Some patients have had all three kinds of treatment before the heart lesions can be corrected totally. Nowadays very few congenital heart diseases are regarded as not treatable. Even for the extremely complicated heart lesions some form of treatment can be offered to relieve the symptom or to achieve partial if not complete correction.
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