Open Heart Surgery For Children in Jordan
جراحة القلب المفتوح للأطفال
Open-heart surgery in children repairs a defect in the structure of the heart, its valves or its great vessels through an opening in the chest, with the child connected to a heart-lung bypass machine so the heart can be stopped temporarily while the machine takes over the circulation and the surgeon works inside the chambers. It is used for conditions such as holes between the ventricles or atria, tetralogy of Fallot, narrowed valves or aorta, transposition of the great arteries, and complex defects that require staged operations. Not every heart defect in a child needs open surgery. Some small holes close on their own as the child grows, others can be treated by catheter intervention through the blood vessels without opening the chest, and some cases are deliberately delayed until a certain weight or age. The decision rests on clinical examination, echocardiography and sometimes diagnostic catheterisation rather than on general reading, and it is made jointly by the paediatric cardiologist, the surgeon, the anaesthetist and the intensive care team. The limits of surgery should be clear from the start. Repair corrects the structural problem but does not create a heart identical to a normal one: some children need lifelong cardiac follow-up, a later procedure to enlarge or replace a valve or conduit as they grow, or medication for a period. Surgery by itself does not fix the poor weight gain caused by a strained heart, though it opens the door for catch-up growth with proper feeding, and it does not remove the need for endocarditis prevention in the specific situations your doctor identifies. Families should also expect a planned stay in paediatric intensive care afterwards, with a breathing tube, chest drains and intravenous lines; this is a normal part of the pathway, not a sign that something has gone wrong. Ask the team for the exact name of the defect, for the staging plan if more than one operation is intended, and for the warning signs after discharge, and keep every report and echocardiogram, because they underpin every decision for the rest of your child's life.
Procedure steps
- 1
Preoperative assessment and timing
The child's history, growth and feeding are reviewed, and echocardiography, an ECG, blood tests and a chest X-ray are performed, with diagnostic catheterisation or CT added when vessel anatomy must be mapped in detail. The type of repair and its timing are set, and any chest infection or anaemia is treated before the date.
- 2
Anaesthesia, monitoring and lines
The child receives full general anaesthesia, and central venous and arterial lines are placed for pressure monitoring and blood sampling, along with a breathing tube and monitors for temperature and brain oxygenation. Matched blood units are reserved in advance, and warming or cooling covers keep body temperature controlled during the operation.
- 3
Opening the chest and going on bypass
The chest is usually opened through the breastbone and the sac around the heart is exposed, then tubes are connected to the heart and great vessels so blood is diverted to the heart-lung machine, which oxygenates it and pumps it around the body. The heart is stopped with a special solution and cooled so the surgeon can work safely inside it.
- 4
Repairing the defect and restarting the heart
The defect is repaired according to its type: closing a hole with a patch of the child's own tissue or a synthetic material, enlarging a narrowed pathway, repairing or replacing a valve, or redirecting vessels. The heart is then rewarmed and restarted, and the repair is checked by echocardiography inside the operating room before coming off bypass.
- 5
Chest closure and intensive care
Chest drains and temporary pacing wires are placed, the breastbone is closed with wires and the skin is sutured. The child is transferred to intensive care on a ventilator and weaned from it gradually as heart rhythm and oxygen levels settle, after which the drains are removed and feeding and movement are restarted before transfer to the ward.
Before the procedure
Tell the team about every medicine your child takes, including diuretics, heart medicines, blood thinners and any supplements or herbal products, and do not stop anything without instruction. Report drug or food allergies, any family history of unusual bleeding, and any previous operation or anaesthetic and how your child responded. Notify the hospital about any cough, fever, diarrhoea or new rash before the date even if it seems minor, because the operation may be postponed for safety. Follow the fasting hours set for your child's age and the exact instructions about milk and water. Complete the required vaccinations in advance and bring all echocardiogram, catheterisation and laboratory reports. Prepare your child with honest, simple words suited to their age, bring a familiar blanket or toy, and arrange for one parent to stay, accommodation nearby and enough leave from work to cover the admission.
After the procedure
Give medicines exactly as scheduled, never change a dose or stop a drug on your own, and ask which medicines need follow-up blood tests. Keep the chest wound clean and dry as instructed, apply no creams to it, avoid lifting your child under the armpits or pulling on the arms, and avoid activities that strain the chest for the period you are told, supporting the back and bottom when carrying a small child. Provide the feeding plan you were given, offer smaller and more frequent feeds if your child tires quickly, and record the weight weekly at first. Seek care immediately for fever, redness, swelling, discharge or odour from the wound, any clicking or movement of the breastbone, breathlessness or fast breathing, blue lips, heavy sweating during feeds, lethargy and refusal to eat, static or falling weight, an irregular pulse or fainting. Keep every follow-up and echocardiogram appointment even when your child looks well.
Expected duration
The operation usually takes three to six hours in theatre depending on the type and complexity of the defect, with additional time for anaesthesia, preparation and transfer. The stay generally begins with one to three days in paediatric intensive care, and total hospital admission is typically five days to about two weeks.
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