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A Specialist Timeline of CHD Treatment

Overwhelmed is a word many parents use to describe discovering that their baby has a Congenital Heart Defect (CHD). Whether the suspicion of CHD arises from the presentation of murmurs during a checkup or bluish skin at birth, it is guaranteed that you will move through and meet an ocean of specialists who have dedicated their lives to trying their best to give your baby a chance at life. The severity and type of CHD will determine whether your baby requires immediate surgery or not. When a defect is fairly insignificant, having to visit and be treated by a wave of specialists can be avoided, since the defects will correct themselves as the child ages. Other defects require that the full set be visited, ensuring optimal longevity and minimal surgical invasions.


The first wave of referral is to that of a Paediatric Cardiologist: practitioners that have specialised in the treatment of congenital or acquired heart defects in children and infants. Within the multidisciplinary team involved in, and required for, CHD treatment, they are primarily responsible for the diagnosis of the heart defect(s). There are a range of diagnostic tests the Paediatric Cardiologist can make use of - the most thorough and insightful being that of Cardiac catheterization, performed in a Cath Lab, often staffed by a team of different specialists and lead by the Paediatric Cardiologist. The test involves the insertion of a catheter (a thin, flexible tube) into a blood vessel at your baby's groin and guided through it into their heart. The test produces detailed views of the heart and its defects, allowing for planning of treatment choices, in other words whether the defect can be treated in the cath lab or whether an operation in theatre is necessary. If the defect presents as serious and in need of immediate treatment, Cardiothoracic Surgeons constitute the second wave of treatment - specialists in surgical procedures of the heart, lungs and other organs in the chest area. Many CHDs are corrected using open-heart surgery, whereby the chest is opened to reach the heart. In the Operating Room: Alongside the Cardiothoracic Surgeon is an Anaesthetist, who administers General Anaesthetic


and monitors your baby's heart rhythm, blood pressure, body temperature, level of consciousness, and the amount of oxygen in the blood during the procedure. A Perfusionist is always present during surgery, irrelevant of whether the heart-lung machine is thought to be required or not. Perfusionists operate the machines that keep a patient alive during serious procedures, taking over the role of the heart and lungs when they need to stop to be surgically rectified. In the cases of open-heart surgery, this allows the blood to bypass the heart so the heart can be emptied, opened and repaired.

Scrub nurses work with the surgeons during operations - handing them specific tools, setting up the theatre prior to surgery and preparing the patient to move into the Cardiothoracic Intensive Care Unit (CTICU), in the case of Maboneng Heart and Lung Institute. Nurses and Technicians act as life rings in the sea of surgery, supporting the specialist doctors where needed and necessary.

Recovery: Following the procedure, the CTICU holds dear an array of specialist nurses, with a 1:1 ratio of nurse to patient. Together with the nurses, your baby is monitored by a Paediatric Intensivist - a specialist doctor in caring for ill infants and children, and Cardiothoracic Surgeons perform daily CTICU ward visits, monitoring your baby’s heart and post-procedure progress. Pulmonologists, primarily responsible for the lungs, too form part of the team: in authority of ventilation and moving patients off of life-support. The recovery process often presents itself as a set of swells moving through the ocean: highs or good days followed by days in which the patients are required to fight harder than usual. The duration of your baby’s stay in hospital is largely dependent on their heart defect and the procedure that was performed.

 

© Maboneng Heart and Lung Institute 2017 | Images: Malaika Boon Sources: http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/CareTreatmentforCongenitalHeartDefects/Congenital-Heart-Defects-Surgery_UCM_307729_Article.jsp#.WgveRhOCzPA; https://www.mayoclinic.org/diseases-conditions/congenital-heart-defects-children/diagnosis-treatment/drc-20350080; https://www.bhf.org.uk/heart-matters-magazine/medical/what-to-expect-in-a-cath-lab; http://www.innerbody.com/careers-in-health/how-to-become-a-perfusionist.html; https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/paediatrics/paediatric-cardiology; https://www.sokanu.com/careers/anesthesiologist/; http://work.chron.com/roles-scrub-nurse-3069.html; http://www.wisegeek.com/what-is-a-pediatric-intensivist.htm



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