Pediatric Cardiology

Pediatric Cardiovascular Surgery: Types, Procedures and Recovery

Posted on by Prof. Dr. İbrahim Cansaran TANIDIR

Pediatric cardiovascular surgery is the surgical treatment of congenital heart diseases and vascular anomalies from infancy to adolescence. This discipline aims to enable children to live a healthy life by permanently repairing structural problems such as holes in the heart, vascular obstructions, or valve disorders. Thanks to advancing technology and expert hands, even the most difficult defects in tiny bodies can be safely corrected. Pediatric cardiac surgery is one of the most critical fields of medical intervention that enables a child to hold on to life in the strongest way, and today it offers miraculous results by minimizing vital risks with modern methods.

What Is Pediatric Cardiovascular Surgery and Why Is It Such a Special Field?

Heart diseases seen in adults are usually related to years of lifestyle habits, aging, or vascular occlusions. However, the situation is completely different in babies and children. Problems in a baby’s heart are entirely related to congenital structural architectural defects. You can think of the heart as a house with rooms and plumbing. Problems in babies are conditions that require completely physical repair, such as holes in the walls between rooms, water pipes being connected to the wrong rooms, or one of the pipes being blocked from birth. Rearranging this architecture requires extraordinary delicacy. Babies’ tissues are as delicate as a wet napkin. Therefore, Pediatric Cardiovascular Surgery is a highly specialized art far beyond standard surgical rules, with its own rules and instruments, where the margin of error cannot even be measured in millimeters.

How Has the Field of Pediatric Cardiovascular Surgery Developed Historically in Turkey?

The development of this field in our country has a proud story that captured the golden age of medicine. In the 1950s, when direct intervention inside the heart was not yet possible in the world, physicians in our country courageously performed the first closed operations from the outside without stopping the heart. However, the real major revolution occurred with the arrival of the heart-lung machine in Turkey, which temporarily took over the function of the heart and lungs. Thanks to this machine, the inside of the heart could be made completely bloodless and motionless, and holes in the walls or problems in the valves could be seen and repaired with sutures. The first open-heart surgeries performed in the early 1960s laid the foundation of the modern system that saves the lives of thousands of babies today. Over time, this accumulation of knowledge turned into an academic legacy and enabled the establishment of a network of expertise that resonated not only in major cities but throughout the country.

Some historical centers that pioneered this field in our country are:

  • Hacettepe University Hospital
  • Istanbul Institute of Cardiology (Cerrahpaşa University)
  • Siyami Ersek Thoracic and Cardiovascular Surgery Hospital
  • Kartal Koşuyolu Heart Hospital
  • Ege University Faculty of Medicine Hospital
  • Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Hospital
  • Ankara City Hospital

How Frequently Is the Need for Pediatric Cardiovascular Surgery Seen in Our Country?

Turkey is a country where many births occur every year due to its young and dynamic population. According to statistical data, approximately 10,000-13,000 of the thousands of babies born in our country every year open their eyes to the world with a congenital heart disease. This figure may sound frightening at first, but the healthcare system and expert teams are fully prepared for this issue. Approximately half of these babies need an emergency or planned intervention within the first year of their lives. Families naturally feel great concern when they hear that their baby has a heart problem. However, it should be known that this is actually a routine process that the medical world encounters every day, with diagnostic and treatment pathways clearly determined. With early intervention, the vast majority of these children step into a completely normal, unrestricted, and long life.

Which Methods Are Used for Diagnostic Purposes Before Pediatric Cardiovascular Surgery?

In order to repair a problem perfectly, it is first necessary to see it flawlessly. The diagnostic stage is the most important step that draws the roadmap of treatment. Today, this mapping process is performed with echocardiography devices that work with ultrasound waves, do not contain radiation, and cause no pain or harm to the baby. These devices are so advanced that holes or vascular problems in the baby’s heart can be detected even while the baby is still in the womb. Sometimes, catheterization procedures are performed by entering through a thin vessel in the groin and reaching the heart in order to measure the pressures inside the heart or to see the anatomy of the vessels in more detail. All these methods present a three-dimensional model of the heart before the eyes of specialists.

The main diagnostic tools frequently used are:

  • Fetal echocardiography
  • Transthoracic echocardiography
  • Cardiac catheterization (Angiography)
  • Electrocardiography
  • 24-hour rhythm Holter device
  • Cardiac magnetic resonance imaging (MRI)
  • Cardiac computed tomography (CT)

How Does the Council System Work When Deciding on Pediatric Cardiovascular Surgery?

In medicine, the most accurate decision is never the decision of a single person. When it comes to babies’ hearts, councils where different specialties come together are held to make flawless planning. Around this large meeting table sit pediatric cardiologists who diagnose the heart disease, surgeons who will perform the operation, anesthesiologists who will put the baby to sleep and keep the baby alive throughout the operation, and intensive care physicians who will care for the baby after the operation. Images of the baby’s heart are projected onto the screen and discussed from every angle. Where to approach the chest cavity, which materials to use to repair the heart, and in which month the operation will be safest according to the baby’s development are decided with common reasoning. This teamwork is the greatest secret of surgical success.

What Factors Affect Success Rates in Pediatric Cardiovascular Surgery?

One of the topics families are naturally most curious about is the risks of surgery. In modern medicine, decisions are made not according to assumptions or feelings, but according to internationally valid mathematical data and risk scores. The degree of difficulty of every heart disease is not the same. If only a small hole will be closed, the risk is extremely low and the success rate is almost close to one hundred percent. However, in very complex conditions where half of the heart has not developed at all or the main vessels are completely connected in reverse, the difficulty of the operation increases. Centers in Turkey continuously compare their success rates with world standards and provide families with the most transparent and accurate information.

Some conditions that are relatively easier to repair are:

  • Atrial septal defect
  • Ventricular septal defect
  • Aortic coarctation
  • Pulmonary valve stenosis

Conditions requiring more complex repairs are:

  • Transposition of the great arteries
  • Hypoplastic left heart syndrome
  • Hypoplastic right heart syndrome
  • Tricuspid atresia
  • Double outlet right ventricle

How Are Heart Holes Repaired Within the Scope of Pediatric Cardiovascular Surgery?

You can imagine the structure of the heart as a small two-story house with four rooms. There are two small rooms upstairs and two large rooms with thick walls downstairs that pump blood to the whole body and lungs. Normally, there are solid walls between these rooms that prevent blood from mixing. However, in some babies, there is a congenital opening, that is, a hole, in these walls. The presence of this hole causes oxygen-rich clean blood and oxygen-poor blood that has not yet been cleaned to mix with each other. As a result, more blood than necessary is pumped to the lungs, and over time the heart becomes tired, causing shortness of breath and growth retardation. During surgery, these holes are usually completely closed with the precision of a tailor by suturing them with a small piece of tissue taken from the child’s own pericardium or with special synthetic patches compatible with tissue. Over time, the heart’s own cells cover this patch, and the patch becomes a natural part of the heart.

How Is Aortic Coarctation Treated in Pediatric Cardiovascular Surgery Practices?

The aorta is the largest highway of the body, emerging from the heart and carrying clean blood to our brain, internal organs, and legs. In some babies, a serious narrowing occurs at a certain point of this main vessel. We can compare this situation to a garden hose being tightly bent at one point while watering the garden. In the area before the narrowing, namely the heart, head, and arms, blood pressure rises dangerously, while enough blood cannot reach the kidneys, intestines, and legs beyond the narrowing. This is a mechanical problem, and its solution is also mechanical. In the operation, this narrowed area is reached by opening a small window only between the left ribs without opening the breastbone. The narrowed segment is carefully cut out, and the two healthy ends of the vessel are sutured together smoothly. Thus, the traffic jam on the highway is eliminated.

What Solution Does Pediatric Cardiovascular Surgery Offer in Diseases Accompanied by Cyanosis?

The condition popularly known as blue baby disease is caused by the presence of multiple architectural defects in the heart at the same time. The best-known example of this is a disease called Tetralogy of Fallot. In these babies, the pathway to the lungs is very narrow, so blood cannot reach the lungs sufficiently to be cleaned. Dirty blood that cannot go to the lungs passes through a large hole in the heart and spreads directly to the body. Since oxygen-poor blood is pumped to the body, marked bluish discoloration is seen on the lips and fingertips when the baby cries or gets tired. In surgery, this narrowed lung pathway is carefully widened and the large hole causing the blood to mix is completely closed with a strong patch. Since the blood will now go only to the lungs, be cleaned, and then distribute to the body, the baby gains the chance to grow healthily without fear of cyanosis.

The main structural disorders seen in this disease (Tetralogy of Fallot) are:

  • Large hole between the ventricles
  • Narrowing of the pulmonary artery
  • Thickening of the right ventricular muscle
  • Incorrect positioning of the aorta

How Does Pediatric Cardiovascular Surgery Save Lives When the Vessels Are Connected in Reverse?

In a normal and healthy system, the right side of the heart sends dirty blood to the lungs to be cleaned, while the left side receives the cleaned blood and pumps it to the body. In the disease called Transposition of the Great Arteries, the connection points of these main pipes are congenitally reversed. The vessel that should carry clean blood is connected to the lungs, while the vessel that should carry dirty blood is connected to the body. In this case, dirty blood constantly circulates in the body and oxygen levels drop rapidly. This is an urgent struggle for life for the baby. With an operation performed when the baby is only a few days old and considered the peak of surgery, these giant vessels are cut from their places and sutured to the correct chambers where they belong. Even the hair-thin capillary coronary vessels that feed the heart are moved one by one to their new locations with the help of special magnifying glasses. In this way, the circulatory system is completely returned to its normal functioning.

What Is Fontan Circulation Within the Scope of Pediatric Cardiovascular Surgery in Half-Heart Conditions?

In some rare cases, babies are born with very severe conditions in which the left or right main pump of the heart is completely missing or has never developed. One of the two large engine rooms on the lower floor of the house has never been built. Since medical science cannot yet create new heart muscle from nothing, it is necessary to design a new plumbing system that will use the single existing chamber in the most efficient way. The aim is to reserve that single and strong chamber in the heart only for pumping clean blood to the body, and to direct dirty blood returning from the body directly to the lungs through pipes without letting it pass through the heart. This is a long journey and is completed step by step over several years according to the baby’s growth stages.

The basic steps of this reconstruction process are:

  • Temporary shunt procedure in the neonatal period
  • Glenn operation performed months later
  • Fontan operation performed in childhood

Why Is the Small Incision Method Advantageous for Pediatric Cardiovascular Surgery?

In previous years, for the repair of holes or valve problems inside the heart, the breastbone had to be opened lengthwise right from the middle. However, with the development of today’s medical technology, less damaging small incision methods are now used. Especially in surgeries performed through the armpit or the side of the chest between the ribs, bone or muscle tissues are not cut; they are only separated to reach the heart. The greatest beauty of this method is that the integrity of the child’s breastbone is not disrupted after surgery. The recovery process is much faster compared to standard operations, and children are discharged from the hospital very quickly. In addition, especially in girls, the absence of a prominent surgical scar visible from the front provides tremendous comfort for their psychological development and self-confidence in later ages.

How Do Hybrid Operating Rooms Facilitate the Pediatric Cardiovascular Surgery Process?

Hybrid methods, called the medicine of the future, are a magnificent system in which the manual skill of surgery and the technological power of cardiology combine at the same time, in the same room. Traditionally, open surgeries are performed in the operating room, while closed intravascular procedures are performed in angiography units. However, hybrid operating rooms combine these two. If a very small and delicate baby has more than one heart hole, completely opening the chest and connecting the baby to a large heart-lung machine may be very tiring. Instead, the surgeon opens a tiny window in the chest. At that moment, the cardiologist enters the heart directly with special catheters through this window opened by the surgeon and closes the holes from the inside with umbrella-like devices. The heart is never stopped and is not connected to a machine. In this way, even the most fragile babies are treated with the lowest trauma.

In Which Situations Is the ECMO Device Used After Pediatric Cardiovascular Surgery?

Sometimes, when the repair of the heart takes a very long time or when the baby already enters surgery with a very tired heart, after the operation is completed, the heart may not immediately have the strength to pump enough blood to the body on its own. Think of how your leg muscles swell and cannot carry you after running a long marathon. The heart muscle may also swell just like this after major operations and experience temporary fatigue. Forcing this tired heart causes irreversible damage. In this situation, a highly advanced external life support unit called ECMO is activated. This machine takes blood out of the body through tubes connected to the neck or chest vessels, oxygenates it, and pumps it back into the body. Thus, the heart rests for days without doing any work and eliminates its edema. As the heart gradually regains its own strength, the support of the machine is reduced, and eventually the patient continues to breathe entirely with their own heart.

How Does the Intensive Care Process Progress After Pediatric Cardiovascular Surgery?

The place where the flawless sutures placed and the repair performed in the operating room truly come to life is the pediatric cardiovascular surgery intensive care units. When the operation is over and the baby is transported to intensive care, a huge medical army in which even seconds are calculated accompanies the baby. The first hours and days are the period when everything is most delicate. It is not desired for the baby to feel pain because pain increases stress hormones, and stress accelerates and tires the heart. Therefore, babies are kept in a deep sleep with strong but safe medications. The aim is for the body to spend all its energy only on healing and the fusion of the repaired walls of the heart. The removal of excess fluids from the body and the safe re-expansion and deflation of the lungs are monitored every second by computerized systems.

The most critical values monitored moment by moment in intensive care are:

  • Heart rhythm
  • Blood oxygen level
  • Arterial blood pressure
  • Central venous pressure
  • Body temperature
  • Respiratory rate
  • Hourly urine output

What Awaits Individuals Who Have Undergone Pediatric Cardiovascular Surgery in Adulthood?

The most beautiful result of these dazzling developments in the medical world is that more than ninety percent of babies born with congenital heart disease can now step into adulthood, school years, working life, and even parenthood in a healthy way. However, it is very important that individuals whose hearts have been repaired do not stop doctor follow-ups with the thought, “I had surgery, the disease is completely over.” Even if repaired, the heart requires special attention. These individuals who reach adulthood are regularly monitored for life in adult congenital heart disease units specialized only in this field. The regularity of heart rhythms, the performance of the heart muscle, and the condition of organs such as the liver and kidneys are checked at certain intervals. Life does not stop for these patients; they do appropriate exercises, engage in sports, and can safely hold their own children in their arms under the supervision of a specialist medical team.

Güncellenme Tarihi: 13.10.2026

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