Definition and Overview
Paediatric cardiothoracic surgery follow-up is an appointment with the surgeon after surgery and is an integral part of the child’s aftercare.
Paediatrics is a branch of medicine that focuses on patients below 21 years old, including newborns. Cardiothoracic surgical procedures performed on these patients are often related to genetic defects that affect the heart.
The heart is one of the strongest organs in the body and is responsible for pumping blood 24 hours a day, 7 days week, throughout a person’s life. Its right side delivers blood to the lungs, so it is enriched with oxygen, which then travels to the left side where the heart pumps it to the arteries and other blood vessels, distributing it to all parts of the body.
If there’s a heart defect, normally because of the way it’s structured, it can cause blood distribution problems that can lead to cardiovascular death.
There are many different types of possible congenital heart defects including septal hole, stenotic (narrowed) valve, and tetralogy of fallot (a heart condition that involves four abnormalities occurring together including the narrowing of the pulmonary artery), among others. Many of these heart problems require invasive surgical procedures.
Who Should Undergo and Expected Results
A paediatric cardiothoracic surgery follow-up is recommended to:
Those who have undergone the surgery – The follow-up is part of the child’s after care to ensure that the patient is healing nicely and according to the expectations of the doctor.
Patients who are considered high risk – A cardiothoracic surgery has a number of risks and complications, which include bleeding, infection, breathing difficulty, and allergic reaction to medications. Minimizing these risks is crucial, as evidenced by a Finnish study. It involved 6,000 patients who had undergone surgery for their congenital heart disease (CHD) and most of them died due to CHD-related complications.
Individuals who are referred by their other doctors – There are cases wherein the patient has to return for a follow-up as part of the consultative process. It could be that another doctor needs the expertise of the surgeon to help him come up with a clearer diagnosis or better treatment options for the patient.
Patients who need clearance – Many children who have gone through surgery can engage in physical activities. However, before they can do so, they are required to present a clearance from their surgeon to guarantee they are fit to participate. Dentists may also require one as dental procedures may lead to life-threatening heart infections.
A follow-up is necessary because:
- Children cope or deal with an ailment or procedure differently from adults.
- Complications can occur after surgery.
- Some children may require long-term care.
How Does the Procedure Work?
A paediatric follow-up commences after discharge. During this time, the parent along with the child and the doctor discuss the schedule, program, and other after-care treatments that have to be performed. For example, the doctor will show the parents how to dress the wound or watch for possible signs of infection. The doctor will also talk about the kinds of activities the child may have to avoid until he fully recovers from the procedure.
The follow-up schedule depends on many factors and the health care program. Normally, the first follow-up happens between 10 and 14 days after discharge and typically involves a physical exam and an interview wherein the parents or the child shares concerns such as pain, discomfort, difficulty in breathing, and fever. Depending on the severity of the patient’s concerns, the surgeon may request for additional tests, including imaging exams like X-ray or MRI.
A follow-up care may also involve a paediatrician, who works closely with the cardiothoracic surgeon if patients below 21 years old undergo surgical procedures. One of the main objectives of a pediatrician is to help the patient cope with the surgery not only while on recovery but most especially in the long term. Since the patient spends more time with the paediatrician while growing up, the doctor is more capable of spotting problems that may be related or caused by the surgery.
Meanwhile, depending on the overall health condition and outlook, the patient may need to see the cardiothoracic surgeon at least once or twice a year for a few years.
Possible Risks and Complications
A number of children may not appreciate the idea of visiting doctors regularly, and their attitude toward it may prevent health care professionals from providing the right type and amount of after care. A way to curb this is to coordinate with the parents, so the child fully understands the importance of going through a follow-up.
Chung DH. Paediatric surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 13.
Neumayer L, Vargo D. Principles of preoperative and operative surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 11.