Pediatric cardiologists follow children with known heart defects and present them to the pediatric cardiothoracic surgeon at a time when surgery is the best recourse. Sometimes surgical timing depends upon age/weight/medical status of the child, and sometimes it is more urgent, dependent upon the life-threatening nature of some of these problems. Each situation is unique, but in general the cardiologist and cardiothoracic surgeon will talk to you about the nature of the surgery, and the staff will set up a surgery appointment.
At a pre-operative appointment, patients will come the day prior to surgery to have laboratory tests, chest x-ray, and echocardiogram done in preparation for surgery. A history and physical exam will be performed, and surgical consent will be explained and obtained by the surgical team.
On the day of surgery, you will be asked to check in on the 3rd floor of the Children’s Hospital of Georgia at the Operating Room main desk. Children can pick a toy out, and are taken back to the Phase-I area of the Peri-operative Care Unit. Clothes are changed, the anesthesia and surgical teams speak with the patient and family, and often a pre-operative medication is given to the patient to help decrease anxiety. Usually patients are taken back to the operating room, breath some inhaled anesthetic agents to go to sleep, and have all other procedures performed after they are asleep. The entire experience is kept as patient- and family-friendly as possible. Once children are finished with surgery, parents are encouraged to spend time with them in the pediatric ICU.
Following open-heart procedures, patients go directly to the Pediatric Intensive Care Unit (PICU). Patients will be taken care of by a team consists of special intensivists or neonatologists as well as, cardiologists, cardiothoracic surgeon and nurses dedicated to children with heart disease. The Cardiology Service follows and cares for the patients on the floor with close involvement of surgical team prior to their discharge home.
Patients usually follow up with Cardiology and Cardiothoracic Surgery after about 2 weeks, and sometimes again 6 weeks thereafter. If families travel from a long distance, they may be followed in outreach clinics. The Patients are then followed on an individual basis, usually at least annually by their cardiologist.
Will my child need blood?
Majority of the open-heart surgeries requires blood transfusion. Special measures are taken to save as much blood from the surgery as possible and give it back to the patient at the end of the surgery. Because the amount of blood loss can be large, or because the patient may be so small, it is important to anticipate the need for blood. If you have religious convictions against the transfusion of blood or blood products, please discuss this carefully with the team ahead of time.
We generally discourage this practice, for a number of reasons. Parents will be very important caregivers during a child’s hospitalization, and should stay as healthy as possible themselves. For surgery, all blood is tested for compatibility with the child’s blood, as well as extensively tested for viruses or other diseases. If family members wish to donate blood to the hospital in general, that will increase the available supply. They will go through the same screening process as any other donor. (Blood donated exclusively for your child will be used only for your child, or will be discarded.)
There is a fold-out chair in each PICU room for an adult to stay with a patient at all times. We try to help families get registered with the Ronald McDonald House if more than one parent will be coming for surgery, or if it will be helpful to have a place to go between visits. The surgical floor hospital rooms are all equipped with a window-seat bed and a trundle bed, allowing space for 2 adults to stay in the room with a patient. There are also kitchen areas and a washer/dryer available for use on the floor.
Most patients undergoing open-heart procedures will have to stay in the ICU for a few days or longer. Time on the surgical floor depends upon a number of factors such as feeding, heart rhythm abnormality, oxygen requirements, or anticoagulation with Coumadin. Ask the surgeon about length of stay, since the time could be longer or shorter, depending upon the severity of the operation.
Usually absorbable stitches are used on the chest scar. There are occasionally some stitches associated with tubes or drains which must be removed, but these are typically done in the hospital or need to be taken out by the local pediatrician within one week from the day of surgery.
Please ask your surgical team about this. It varies, depending upon the type of procedure.
If your child has open-heart surgery, it causes some changes in fluid balances. They usually have some swelling of the body and the intestine after surgery which slows down digestion of food. It is recommended to wait a couple of days after surgery to start feeding the child when the swelling subsides.
There is a chapel located on the first floor of the CHOG, and 3 full-time chaplains are on staff. One is always on call, and they are happy to come and pray with families or discuss difficulties you may be going through.