It is not necessary to undergo surgery for all cases of heart murmur, because, in most cases, it is a benign situation and the person can live with it normally without major health problems. Also, in babies and children it is very common for the murmur to last only a few months or years and resolve naturally as the heart structures are still developing.
Thus, surgery is indicated in cases where the murmur is caused by some disease, of the muscles or valves of the heart, which impairs its functioning, such as a severe narrowing or insufficiency, to the point of causing symptoms such as shortness of breath, tiredness or palpitations, for example.
How is the surgery done
Surgery to correct a heart disease is indicated by the cardiologist and the cardiac surgeon, who jointly decide on the best type of surgery for the change for each person.
Often, before surgery, treatment with drugs can be tried to improve the condition and control the symptoms, with the use of Hydralazine, Captopril or Furosemide, for example, which can be useful for some people. However, when symptoms are severe or do not improve with medication, a surgical procedure may be the best alternative to improve the quality of life of the baby or adult.
To schedule the surgery, a preoperative evaluation is performed, with a battery of blood tests, such as blood count and coagulogram, and imaging tests, such as echocardiogram, electrocardiogram, chest X-ray and cardiac catheterization, for example.
Types of surgery
The surgery, for both the child and the adult, is performed according to the defect in the heart that must be corrected, which can be:
- Heart valve narrowing, which arises in diseases such as mitral, aortic, pulmonary or tricuspid stenosis: a balloon dilatation can be done, through a catheter that is inserted into the heart and that inflates the balloon in the exact location, or by surgery, in which the heart for valve correction or, in some cases, it is replaced by an artificial valve;
- Valve insufficiency, which happens in cases of mitral valve prolapse or valve insufficiency, such as aortic, mitral, pulmonary and tricuspid valves: surgery can be performed to correct the defect in the valve or replacement of the valve by an artificial one;
- Congenic cardiopatics, as happens in babies with interatrial (IAC) or interventricular (IVC) communications, severe patent ductus arteriosus, or tetralogy of Fallot, for example: surgery is performed to correct the defect in the heart muscle.
In most cases, a single procedure is needed to improve heart function and reduce symptoms, however, in more complicated cases, more than one surgery may be needed.
How to prepare for surgery
Surgery requires a fasting period, which varies according to age, with an average of 4 to 6 hours for babies and 8 hours for children over 3 years and adults. The procedure is done under general anesthesia, and the duration of surgery depends on its type, but varies between about 4 to 8 hours.
Any cardiac surgery is delicate, as it involves the heart and blood circulation, however, currently the risks are low, due to new technologies in medicine and surgical materials.
Some complications that can hardly happen in cardiac surgery are bleeding, infection, heart attack, cardiac arrest or valve rejection, for example. These types of complications can be avoided with a well-done pre- and post-operative period, following all the doctor’s instructions.
How is recovery
After surgery, the postoperative period is done in the ICU, for about 2 days, and then the follow-up starts in the nurse’s room, where the child or adult can stay for about 7 days, with cardiologist evaluations, until the discharged from hospital. During this period, in addition to the use of medicines for discomfort and pain, such as paracetamol, physiotherapy can be started to rehabilitate strength and breathing after surgery.
After being discharged home, some guidelines should be followed, such as:
- Use the medicines prescribed by the doctor;
- Make no effort, except those recommended by the physiotherapist;
- Have a balanced diet, with a diet rich in fiber, fruits, vegetables and whole grains, such as oats and flaxseed, and avoiding fatty or salty foods;
- Go to return appointments with the cardiologist for reassessments.
In addition, it is recommended to anticipate the return or immediately contact the doctor in cases of fever above 38°C, severe shortness of breath, severe pain, bleeding or pus in the scar.