treatment of congenital heart defects is often expensive and emotionally
draining. Successful treatment requires highly specialized care (American
Heart Association, 2001).
first successful open heart surgery was performed in 1952 when Dr. John
Lewis repaired an atrial-septal defect in a five-year-old girl (Kleinert,
This is one of the simplest reconstructive surgeries for congenital
heart disease, usually for septal defects. A patch is placed over the
opening to correct the shunting (Abdallah,
(3-stage) Surgical Procedure (Claxon-McKinney,
This procedure involves reconstruction of an infant's heart and supporting
vessels. Often used when there is an anomaly of the left ventricle,
the Norwood allows the right ventricle to act as a systemic chamber.
Repair is done in three stages because an infant's pulmonary vascular
resistance is too high.
1) Newborns: Establishes a permanent unobstructed outflow from the
right ventricle to the aorta and regulates pulmonary blood flow.
2) At 6 months old: Also known as the Hemi-Fontan Procedure or the
Glenn procedure; Involves removal of the ventricular volume overload
imposed by the systemic shunt and connection of the superior vena cava
to the pulmonary arteries, thus reducing ventricular volume load and
increasing tissue oxygenation (by separating pulmonic and systemic circulation).
3) At 2 years old: Also known as the Fontan Procedure; Completes
the separation of the pulmonary and systemic circulation by channelling
the inferior vena cava blood flow to return to the pulmonary arteries.
E is a drug that provides a viable alternative pathway for oxygenating
blood in infants who would die if their ductus arteriosus closed, which
is often provided to an infant until reconstructive surgery can be performed.
Procedure (Abdallah, 2001)
A clip is placed on the ductus arteriosus to close it when an infant
has patent ductus arteriosus. An alternate procedure is the Coil
Operation which is performed through cardiac catheterization.
who have private insurance often undergo surgery at a younger age than
those who are in managed care programs. Surgery for patients on Medicaid
occured at an even later age (Lampe, 2000a).
A negative correlation occurs between the case volume of surtical centers
and the median age at operation: those centers that perform more congenital
heart defect surgery operate at a much younger age. It has not yet been
proven, but is suspected, that operations which occur at a younger age
have an increased beneficial result (Lampe,