Paediatric cardiac surgery in India: a guide for families

What is paediatric cardiac surgery?

Congenital heart defects are structural problems present at birth. NHLBI notes they are the most common type of birth defect. MedlinePlus describes three main ways to treat them:

• Open-heart surgery through the breastbone, using a heart-lung machine while the heart is stopped for repair
• Closed-heart surgery through the side of the chest, usually without a heart-lung machine
• Cardiac catheterisation, where thin tubes are passed through a blood vessel in the leg to repair some defects

MedlinePlus notes that some children need a series of procedures over time. Some defects, such as small holes in the heart wall, may be closed by catheter rather than surgery.

Which children may need surgery?

MedlinePlus lists signs that may mean surgery is needed. They include blue or grey skin, lips or nails, breathing difficulty from fluid on the lungs, abnormal heart rhythms and poor feeding, sleep, growth or development. A paediatric cardiologist and cardiac surgeon decide whether a child needs treatment, which approach suits and when. Timing is part of that decision.

What reports does a paediatric cardiologist ask for?

MedlinePlus lists tests before surgery. These include chest X-ray, ECG, echocardiogram, sometimes cardiac catheterisation, blood tests and a full history and examination. Send:

• Echocardiogram reports and, if possible, the recorded images or video
• ECG and chest X-ray reports
• Catheterisation or CT or MRI reports if done
• Notes of any earlier heart procedures
• The child’s weight, growth and feeding history, oxygen levels and medicines
• Other conditions, such as genetic syndromes, and recent illnesses

MedlinePlus notes that surgery may be postponed if the child has a recent fever, cold or flu. Tell the team about any illness before travel.

How should a family plan the trip?

• Remote review of the echocardiogram and reports
• Assessment in India and repeat echocardiogram
• Surgery or catheter procedure
• Intensive care, then the ward: MedlinePlus describes breathing support, lines and tubes in intensive care, most removed before leaving it
• Discharge and a review before the flight, when the team agrees the child can travel
• Home: regular follow-up with a paediatric cardiologist

MedlinePlus says follow-up with a cardiologist is usually needed regularly. The MedlinePlus Congenital Heart Defects page notes lifelong follow-up is needed even after repair. Two adults travelling with the child makes the stay more manageable. Ask whether a parent can stay with the child on the ward.

What should you ask the hospital?

• Which procedure do you recommend for my child, and why now?
• Is a catheter procedure possible instead of surgery?
• Will further operations be needed as my child grows?
• Can a parent stay with the child, and what support is there for families?
• When will it be safe for my child to fly home?
• Will you send full reports to our cardiologist at home, including advice on dental antibiotics?

IndiaMedica helps families share reports and plan the visit. The treating paediatric cardiac team decides what is suitable and when it is safe to fly.