Correct Timing for Congenital Heart Surgery

Approximately 5,500 USD.

For TGA with VSD and LVOT obstruction, these kids essentially have pulmonary stenosis with a VSD, and timing depends on the kid's oxygen saturation — they will need a Rastelli or a Nikaidoh operation, both requiring an implant, and the intent is to give the biggest implant possible since a smaller implant means an earlier return for a change. If saturations are above 75% and the kid is growing and doing well, they can wait and have surgery at around one year of age; if saturations are less than 75% with significant failure to thrive, they should come for surgery at any age or weight. On late presenters: we are also a resource-limited country — four or five surgeons doing this work for half of India — and face the same problem of kids coming late every day. My suggestion is education programmes, including pulse oximeter screening at birth, 1 month, and 6 months, referring for an echo early if abnormal. Late-presenting PDAs and cyanotic conditions apart from TGA are usually still operable, even if at slightly higher risk, but VSD shunt lesions can become inoperable if too late — however, even when a kid looks clinically inoperable, we always offer a cardiac catheterisation to confirm, since a significant proportion will still turn out to be operable, if high risk. And even an inoperable VSD child, with good, appropriately timed medical management (diuretics, pulmonary vasodilators), can still survive 25–35 years, whereas without that care they will die much earlier.

No. This is a common misunderstanding in India as well as the US, Europe, and the Middle East. Surgical mortality may appear lower in an older, bigger child, but that comparison never counts the children who die during the waiting period. The right approach is to base timing on the natural history of each specific heart condition, weighing the risk of waiting against the risk of surgery.

Timing is decided by the natural history of the specific heart condition, meaning how quickly it is likely to cause death or serious harm if left untreated, rather than by a fixed rule about the child's age or weight.

An atrial septal defect. It is the one heart condition in this series where waiting, until the child is around 3 to 4 years old, is genuinely the correct strategy rather than a compromise.

Most conditions covered in this series, including transposition of the great arteries, patent ductus arteriosus with symptoms, coarctation of the aorta, truncus arteriosus, and complex conditions involving pulmonary stenosis, need treatment at diagnosis or within the first year of life. Delaying surgery in these cases raises the risk of the child becoming inoperable or dying while waiting.

Dr. Aseem R. Srivastava, Chief of Paediatric CTVS and Adult Congenital Heart Diseases at Artemis Hospitals, Gurgaon, who shared this breakdown of surgical timing during a Jivo Masterclass session.