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Preparations for the Heart Surgery?

One individual’s experience before surgery can be altogether different from another’s yet we follow similar planning for most regular procedures.
This is because there are many varieties of heart surgery.
Most people start their journey by contacting specialist doctors and get examined (by a cardiologist) who after a precise diagnosis guides them to the cardiac surgeon. The surgeon plans the operation according to his understanding of the disease and in discussion with the cardiologist.
The patient and their relatives are counselled about the plan of treatment so that they have understood both the disease and the plan of treatment. Most people start preparing themselves very well mentally for the procedure. Then they start to plan their Hospital admission, travel and finances.
On arrival at the hospital, they will be guided to the care of the consultant in charge of the treatment by coordinators. After the consultant re-examines the patient, he/she will be admitted the previous evening for the proposed operation.

Doctors and nurses will re-examine you, take blood and urine samples and other investigations as advised by the consultant. Your consent for all procedures is once more taken and documented. The anesthesiologist will also examine your fitness for the procedure. You may need to have body hair removed by some means to help to operate unhindered. You will be given a special scrubbing solution to have a bath with, so as to reduce the chances of infection.

An intravenous (IV) line will be put into a vein in your arm to give you liquids and medicines. Just before the surgery, you’ll be moved to the operating room. You’ll be given medicines so you are relaxed and stress-free when going to the operation theatre.

The operation will be done after you have been made to go into a deep sleep so that you do not feel any pain. After the planned procedure has been completed you will be brought into the ICU where you will recover from the operation. On waking up you will find many tubes and wires attached to you, there will be sounds of computers and other machines beeping, doctors and nurses talking. This is normal. You may not be able to move or speak for some time, because of the medicines. We will wait for your complete recovery before allowing you to move and then removing the ventilator machine. Now you will be able to speak. 3 to 6 hours after removing the ventilator, you will not be given anything to eat or drink. Only when your recovery is complete will you be transferred to the wards.

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Ventricular septal defect ( VSD )

The  VSD is a defect in the septum that separates left and right ventricles. Blood from the left ventricle, which is at high pressure flows across the VSD, Right ventricle and then into the pulmonary artery. This results in blood reaching the lungs at high pressure. Over a period of time, the blood vessels of the lungs undergo changes and this is called pulmonary hypertension. It is to avoid this that we close the VSD.

How does it look when a surgeon opens the chest?

We see the heart situated between the diaphragm and the collar bones, and between the lungs on either side. The right border of the heart is formed by the right Atrium. The right ventricle forms the front of the heart. The left ventricle lies under the left half of the chest and the left atrium lies behind all these chambers.

To do open-heart surgery, we connect the major veins and arteries, and thereby the patient to the heart-lung machine which takes blood out of the venous system and give it back to the aorta. This is CPB, it ensures a supply of oxygenated blood to the whole body and hence keeps the patient alive, therefore, once we know that heart-lung machine is able to maintain the patient’s cardiac output, we stop the heart by giving potassium-rich solution into the blood vessels supplying the heart muscles. This is known as cardioplegia.

Open Heart Surgery

To close this VSD, we enter through the right Atrium surgically and place a patch on this defect and attach it using stitches. When we look through the oval orifice of the Tricuspid valve we are able to locate the defect in the interventricular septum, the VSD. Through which we can see the inside of the left ventricle. This is the ventricular septal defect that has got to be closed. It is closed by placing a patch and stitching along the edges with suture material, working in the motionless heart. This is VSD closure.

The heart is then closed, all the inside air is taken out and blood is returned to the heart. It is allowed to start beating and once the heart and lung function comes back to normal, we wean the patient off the heart-lung machine and remove the tubes inserted earlier. When the child is safe, we close the chest and shift them to the ICU for care under trained doctors and nurses.

During this entire time, the patient is under anaesthesia and is not aware of any of this activity.

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