Those things with adult congenital heart disease surgery

What are the manifestations of adult congenital heart disease?

Generally speaking, the manifestations of adult congenital heart disease are diverse, mainly including the following aspects:

Patients will develop generalized bruising due to severe hypoxia, which can make life unable to take care of themselves, even going to the bathroom or getting up to wash is a problem, seriously affecting the quality of life. Patients may experience pulmonary hypertension such as hemoptysis, decreased physical strength, fatigue and fatigue, and even sudden death may occur. Most patients will find that the heart is enlarged during the examination. This is due to the perennial disease state that has brought an excessive burden to the heart, which may result in heart failure and eventually death.

Under what circumstances does the patient need surgery?

This question involves the indications for surgery and which patients need surgery. For patients, the most intuitive feeling is whether the body has symptoms.

For patients with asymptomatic symptoms, after part of the examination, the doctor will clearly tell the patient that there is no need for surgery now and can be observed for a period of time. However, observation does not mean that everything is fine. Patients need to come to the hospital for review regularly, perhaps once a year, or once every two or three years. Although another part of the patients has no symptoms, doctors will recommend surgery as soon as possible, because the disease develops regularly, and doctors can assess the patient’s condition in 5 or even 10 years through examination. If it is delayed, it is likely to lose the opportunity for surgery.

For symptomatic patients, most of them require surgery, but unfortunately some patients cannot be operated on. These patients often have more complicated conditions, and the disease has advanced to an advanced stage. Even if surgery is performed, there is no guarantee that the patient will have a better quality of life and a longer life. Therefore, patients can only be recommended for medical treatment.

What checkups do patients need before surgery?

Generally speaking, the doctor will first understand the patient’s condition in detail and conduct a detailed physical examination. Immediately afterwards, we will help the patient to do some routine examinations, such as blood tests, chest radiographs, electrocardiograms, echocardiograms and so on. If the patient is accompanied by arrhythmia and syncope at the same time, an electrophysiological examination may also be required. For some complicated adult congenital heart diseases, CT, MRI, and even cardiac imaging are also required.

These tests not only help to diagnose the disease and judge the condition, but also have guiding significance for the treatment of adult congenital heart disease. For patients, the most concern is whether the effect of the operation is good, whether it can be cured, how many operations, how much it will cost, and whether it will affect it in the future. In fact, every patient’s situation is different. We cannot simply answer the patient with a formula, but through these checks, we can give the patient a clearer answer.

What are the surgical methods for adult congenital heart disease?

In general, there are two surgical methods for adult congenital heart disease: one is the traditional open thoracic surgery, and the other is the minimally invasive surgery that is more accepted now.

Let me first talk about minimally invasive surgery, which mainly includes the following three categories: one is interventional occlusion, which involves puncturing a blood vessel (usually a blood vessel at the root of the thigh) and sending a catheter and occluder to the heart defect for repair. There is almost no incision; the other type is actually a thoracotomy, and there will also be an incision, but it is a small incision, a side incision, and a minimally invasive incision. They are all minimally invasive incisions. You only need to make a few holes in your body to perform the operation.

Which patients can choose minimally invasive surgery?

Generally speaking, only some patients with simple congenital heart disease can perform minimally invasive surgery. Simple congenital heart disease refers to three diseases, patent ductus arteriosus, atrial septal defect, and ventricular septal defect. Although there are not many types, the number of patients is large, and the overall incidence is very high.

The advantages of minimally invasive surgery are obvious, less trauma, faster recovery, and easier for patients to accept. However, minimally invasive surgery also has its limitations. Take interventional blocking as an example. Although there are a lot of developments at present, because the observation time is not long enough and has not passed the test of history, the long-term treatment effect is still uncertain. Therefore, it is necessary to strictly grasp the indications of minimally invasive, so that patients can obtain the best treatment effect.

There are two starting points for the treatment of adult congenital heart disease: the first starting point is safe and effective, which is the first priority. The second is beautiful and minimally invasive. If you blindly pursue aesthetics and minimally invasive, and affect safety and effectiveness, it is not a good choice.

For another surgical method, thoracotomy, in general, all complicated adult congenital heart diseases must undergo thoracotomy, and some patients with simple congenital heart diseases that are not suitable for minimally invasive surgery also need thoracotomy. At present, in Fuwai Hospital, the proportion of patients with simple congenital heart disease undergoing thoracotomy and minimally invasive surgery is almost half to half. Although this trend is very good, it is necessary to pay attention to the long-term recovery of patients, to judge whether all patients are suitable for minimally invasive surgery, and to analyze the specific conditions.

How big is the surgical incision for open chest repair?

Generally speaking, the normal incision is in the middle of the breastbone and is about 10 cm long. For patients with simple congenital heart disease, the surgical incision can be reduced by half, or you can choose to make an incision in the right armpit.

How long is the operation time for adult congenital heart disease?

This is divided into circumstances: for patients with simple congenital heart disease, the occlusion can be completed in about 1 hour, and for thoracotomy, it takes about 2 to 3 hours; for patients with complicated congenital heart disease, the time will be longer. The operation may start in the morning and will not end until the evening.

What factors increase the risk of surgery for adult congenital heart disease?

Each patient’s condition before surgery is definitely different. In addition to congenital heart disease, some patients also have heart problems such as coronary heart disease, valvular disease or cardiac insufficiency.

In addition, if the patient has a second operation or a third operation, the risk of complications or death will increase correspondingly due to more operations. In foreign countries, the mortality rate of the second operation is several percentage points higher than that of the first operation.

There is also a special population, such as elderly patients, who often have diabetes, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, or renal insufficiency, which will increase the risk of surgery.