Correct Timing for Congenital Heart Surgery
Chief - Paediatric Cardio Thoracic and Vascular Surgery (CTVS)
Artemis Hospitals, Gurgaon, India
August 31, 2025
Dr. Aseem R. Srivastava explains why the right time for congenital heart surgery depends on the specific condition's natural history rather than a child's age or weight, and why most conditions besides atrial septal defect need treatment within the first year of life.
Questions Doctors Asked Dr. Aseem R. Srivastava
Real questions from the live masterclass, answered by Dr. Aseem R. Srivastava, Chief - Paediatric Cardio Thoracic and Vascular Surgery (CTVS).
What is the correct timing for a patient with transposition of the great arteries (TGA), VSD, and LVOT obstruction? Also, since we live in a resource-limited country where diagnosis is sometimes made late, and patients may then ask for treatment abroad after a late diagnosis, what is your recommendation for handling late presenters, especially with simple shunt lesions?
Asked by Dr. Aoke (Ethiopia)
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.
— Dr. Aseem R. Srivastava
What is the average cost of ASD closure?
Asked by Dr. William Gataga (Zimbabwe)
Approximately 5,500 USD.
— Dr. Aseem R. Srivastava
Read the Full Article Series
- 1.Correct Timing for Congenital Heart Surgery: A Complete Guide
- 2.Atrial Septal Defect (ASD): Why the Best Age to Close It Is 3 to 4 Years
- 3.AV Canal Defect: Why Surgery Is Needed by 3 to 4 Months of Age
- 4.Coarctation of the Aorta: Why Immediate Surgery Prevents Death and Lifelong Hypertension
- 5.Cost of Congenital Heart Surgery in India
- 6.Late-Presenting Congenital Heart Disease: What to Do When Diagnosis Comes Too Late
- 7.What Makes a Good Paediatric Cardiac Surgery Programme
- 8.Patent Ductus Arteriosus (PDA): When to Close and How
- 9.Total Anomalous Pulmonary Venous Return (TAPVR): Why Surgery Cannot Wait
- 10.Tetralogy of Fallot: Timing of Repair and Why Waiting Is Dangerous
- 11.Transposition of the Great Arteries (TGA): Why Timing Is a Matter of Days
- 12.TGA with VSD and Pulmonary Stenosis: Rastelli and Nikaidoh Procedures
- 13.Truncus Arteriosus: Why Newborns Need Surgery at Diagnosis
- 14.Ventricular Septal Defect (VSD): When Small Holes Close on Their Own and When Surgery Can't Wait
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