Surgical treatment of congenital and acquired heart defects without the heart-lung machine

About the department

The Department of Pediatric Cardiac Surgery at the University Hospital Erlangen offers the full range of modern surgical interventions for congenital and acquired heart defects in children. The surgical treatment corresponds to the highest level of university medicine. All cardiac surgeons working in the department have excellent qualifications and vast clinical experience required for the successful treatment outcomes in the long term. Of particular importance is the optimal preoperative preparation and postoperative care, as well as communication with young patients aimed at establishing a trusting relationship and overcoming the child's fear. Many young patients receive sparing minimally invasive treatment, which excludes severe pain syndrome, high risks of postoperative complications and a long hospital stay. The department is a leader in the area of its specialization in Germany. In addition, the medical facility regularly demonstrates one of the highest success rates in the treatment of pediatric heart pathologies in Europe. The department is headed by  Prof. Dr. med. Oliver Dewald.

The department's team of surgeons successfully treats atrial septal defects – one of the most common congenital heart defects in children. The disorder is the formation of a pathological opening in the interatrial septum. As a result, blood from the left atrium enters the right atrium and overflows the pulmonary vessels. The most common symptoms are fatigue, shortness of breath, and abnormal heart rhythm, but there are also cases when symptoms are absent. Should atrial septal defect be suspected, pediatric cardiac surgeons along with pediatric cardiologists carry out a clinical examination and a complex of laboratory and instrumental tests, including echocardiography, electrocardiography, x-ray, etc. During preliminary diagnostics, doctors determine the exact size of the defect, its hemodynamic characteristics, the presence or absence of comorbidities and other important clinical data, which form the basis for choosing the optimal option for atrial septal defect repair. First of all, experts consider the least invasive technique – image-guided endovascular placement of occluder (without thoracotomy). Such interventions are performed jointly with pediatric cardiologists. However, not all atrial septal defects can be repaired with an occluder. For example, large defects and a combination of the defect with abnormal drainage of the pulmonary veins are contraindications for endovascular procedures. The last-line therapy is classic open surgery with a median sternotomy. During the operation, the patient is connected to a heart-lung machine, which means that the heart temporarily stops, and its defect is sutured or repaired with pericardial tissues. The department's cardiac surgeons regularly perform operations for atrial septal defect repair, so young patients receive safe and highly effective treatment in accordance with high European standards.

The department also specializes in the correction of ventricular septal defects – pathological openings in the interventricular septum. As a result of this anatomical abnormality, blood flows from the left ventricle to the right, which leads to mixing of arterial and venous blood and overflow of the pulmonary circulation. The symptoms include shortness of breath, frequent colds, pneumonia, as well as a delay in physical development. In addition, the ventricular septal defect can contribute to the development of such a serious complication as pulmonary hypertension, which is a contraindication to surgery for heart defect. The main method for diagnosing the defect is echocardiography. In some cases, cardiac catheterization can be additionally performed. When the diagnosis is confirmed, cardiac surgeons begin treatment planning. Whenever possible, preference is given to an endovascular intervention for the placement of an occluder, which completely isolates the ventricles from each other. The endovascular procedure is performed under imaging guidance and is minimally traumatic for the child. Unfortunately, this treatment method is effective only for small and medium-sized ventricular septal defects. If the child has an extensive defect, then open-heart surgery with a heart-lung machine is required. When performing the operation, cardiac surgeons assess the location and size of the defect. If the hole size does not exceed 7-8 mm, it is sutured, otherwise, plastic repair with a patch is carried out. With the timely operation, the child's health condition improves significantly, and he can return to an active lifestyle, including doing sports.

Another priority focus of the department's clinical practice is on the treatment of young patients with tetralogy of Fallot. This pathology is formed even before birth and is an impairment of the development of the right heart. Pulmonary artery stenosis, right ventricular hypertrophy, ventricular septal defect, and aortic dextroposition are typical for tetralogy of Fallot. This disease provokes serious disorders in the circulatory system. The child has cyanosis of the skin and mucous membranes. The disease is characterized by seizures, during which the blood oxygen levels decrease. At the same time, there is a delay in physical development, severe shortness of breath, rapid fatigue during physical exertion and loss of consciousness. Upon admission to the department, doctors conduct comprehensive diagnostics: physical examination, laboratory and instrumental tests, assessment of the blood oxygen levels, blood gas analysis, electrocardiography and chest X-ray, echocardiography, cardiac catheterization and angiocardiography. Based on the diagnostic data obtained, an optimal treatment regimen is developed. As a rule, the department's cardiac surgeons combine drug therapy and surgery, which is the only way to completely cure the defect. During the operation, the patient is connected to a heart-lung machine, after which an incision is made in the middle side of the chest. The surgeon closes the ventricular septal defect with a patch and performs excision of the hypertrophied myocardium, thereby eliminating the obstacle to the outflow of blood from the right ventricle. Thanks to the long experience of the department's specialists and their high professional skills, the risks of developing complications after surgery do not exceed 1%. In the future, the child develops normally, without any restrictions.

The department's main clinical focuses include the following heart surgeries in children:

• Surgical repair of atrial septal defects
• Surgical repair of ventricular septal defects
• Surgical treatment of tetralogy of Fallot
• Surgical repair of double outlet right ventricle
• Surgical repair of partial or total anomalous pulmonary venous drainage
• Surgical repair of the atrioventricular canal
• Tricuspid valve reconstruction for Ebstein's anomaly
• Anatomical repair of transposition of the great vessels, including in case of pulmonary artery stenosis (REV procedure)
• Surgical repair of univentricular defects (Fontan procedure)
• Complex surgical repair and treatment of hypoplastic left heart syndrome (Norwood procedure)
• Ross or Ross-Konno procedure
• Unifocalization for tetralogy of Fallot with pulmonary atresia
• Other heart interventions