Heart Surgery: Open Heart Surgery in Pediatric Patients
Guest: Dr. Anthony Hlavacek – Pediatric Cardiology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I’m Dr. Linda Austin and I’m interviewing Dr. Tony Hlavacek who is a pediatric cardiologist here at the MUSC Children’s Hospital. Dr. Hlavacek, let’s talk some about the experience of children going for heart surgery. I’m sure you’ve had many conversations with parents about what to expect. What are some of the things that parents ask about and what do you tell them?
Dr. Tony Hlavacek: The main thing that parents are worried about is how long their child will be in the hospital, how quickly they should recover, whether they’ll be in pain, and those are all great questions. Generally, the way that it’s done here at MUSC is the children will come to the hospital the day before to get an evaluation
which will include an ultrasound, some blood work, and sitting down and talking with the cardiologists that are going to take care of the patient before and after surgery and, of course, talking to the pediatric cardiovascular surgeon.
That day, we aim to answer all the questions and get all the information we need in order to take care of the patient well with surgery. Then, the next day, you’ll come into surgery. Open heart surgery usually lasts about four to six hours. Afterwards, children will be housed in our pediatric cardiac ICU. But it’s amazing how quickly children can recover after heart surgery.
If a child comes in, for instance, with a ventricular septal defect, oftentimes they’ll be in the ICU for the first night, but the day after that, they’ll go up to a regular floor and the parents can stay with the patient. And usually after about three or four days, the child is able to go home. Kids are very resilient and heal very quickly after heart surgery. It’s kind of amazing, in fact. So, it’s not unreasonable for a child to come in on a Monday and be home by Friday, for the weekend, after having heart surgery.
Dr. Linda Austin: Now, if you were a parent with a child facing that surgery, what would your questions be? They may be different from what a less knowledgeable parent might ask about.
Dr. Tony Hlavacek: Parents are often worried about pain. Children have very pliable, or soft, chests. So, in fact, children undergoing heart surgery experience quite a bit less pain than adults. But all children are given good pain medicine. It’s one of our priorities at MUSC, to make sure that the children have very good pain control while they’re up on the floor. And the parents are given good pain control strategies once the child goes home. So pain is a big concern but most of our children have very good pain control.
Then there’s the scar. Parents are oftentimes worried about the scar. We are very careful to make sure that the scar is very small. It will be noticeable for the rest of their lives but it’s really not too bad.
Dr. Linda Austin: How about the anesthesia? What are some of the things that parents should understand about that?
Dr. Tony Hlavacek: We, obviously, use anesthesia with all of our heart surgery, so
children are evaluated by an anesthesiologist the day before their surgery. During the surgery, the child will be completely out. They won’t remember any of the surgery. They won’t experience any pain during the surgery. And, then, after the child comes back to the intensive care unit, the anesthesia will start wearing off and they should wake up by the afternoon that they have the surgery.
Dr. Linda Austin: How about parents and family visiting right after surgery? What recommendations do you have?
Dr. Tony Hlavacek: Our pediatric cardiac ICU has 24-hour visiting. So, as long as there aren’t any emergencies occurring in the ICU, parents can visit pretty much all day. There are certain situations where we sometimes have to ask everyone to leave, if there’s an emergency or when the nurses are doing their change-up rounds, which is twice a day. But parents can visit and they can bring visitors in, usually one or two at a time. And it’s very important for the patient’s psychosocial well being to have their parents nearby.
Dr. Linda Austin: Can they bring siblings in?
Dr. Tony Hlavacek: Yes. They can bring small children, just so they can see them. It’s usually a quick visit. Small children are usually not allowed to stay in the intensive care unit as visitors for very long.
Dr. Linda Austin: I would think, also, that a small child might be frightened by what goes on in an ICU. If you don’t understand what all the machines are and why a sibling is lying in bed looking kind of wan, that might be scary.
Dr. Tony Hlavacek: It can be very scary and, you know, it’s done on a case-by-case basis. If there are small children that parents think can handle being brought in for a quick look, we’ll allow that. But, usually, it’s just mostly the older children.
Dr. Linda Austin: I think it’s good for parents and kids to know that there is internet access at the bedside these days.
Dr. Tony Hlavacek: Yes, there is.
Dr. Linda Austin: They like that.
Dr. Tony Hlavacek: And a lot of our parents actually make websites and have blogs about their experience with their children going through heart surgery.
Dr. Linda Austin: How long does the full recovery take before a child really has no more restrictions?
Dr. Tony Hlavacek: Usually a couple weeks. You know, when we do heart surgery, we are cutting through a bone in the front of the chest, so it’s like having a broken bone that has to have time to heal. So we usually restrict children, as much as you can restrict a three or four-year-old, somewhat, for about four weeks, just so they don’t cause themselves more pain by putting stress on the bone. But as far as getting up and going outside and playing and doing a lot of the normal kid stuff, it’s usually only about a week.
Dr. Linda Austin: I know that adults who have open heart surgery sometimes have depression that can be significant after that procedure. Do you see that in kids and teenagers?
Dr. Tony Hlavacek: More in teenagers than kids. Children, particularly kids that are in the sort of three to six-year range, oftentimes can’t fully comprehend exactly what’s going on. So, as long as their pain is controlled and they’re around their family and are in a somewhat positive environment, they can actually deal with surgery very well. Children that are a little bit older will worry about it, kids that are about 6 to 12. But as long as their pain is controlled and they’re around their family, usually they’ll tolerate it quite well and, particularly, kids that are in on a Monday and leave on Friday. Teenagers can have more trouble with it, just from our experience. And we have some teenagers that have to come into the hospital a lot and oftentimes they can get a little depressed with having to go through surgery.
Dr. Linda Austin: Dr. Hlavacek, thanks so much for talking with us today.
Dr. Tony Hlavacek: No problem.
If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection: (843) 792-1414.