Before Surgery

Prior to surgery your child will be scheduled for a pre-operative clinic visit. Plan on being at the hospital for four to six hours. During this time you and your child will have the following appointments:

• Surgery Center Pre-Operative Appointment- history and physical examination, meet with anesthesia, discuss your child’s preparation for hospitalization with a Child Life Counselor
• Diagnostic Work-up- this may include chest x-ray, echocardiogram, ECG, and blood work
• Parent’s Meeting with Cardiology Team- overview of hospitalization issues, day of admission information, financial concerns, etc.
• Appointment with Cardiologist
• Appointment with Cardiac Surgeon

Since it is going to be a long day, please do not bring other children. However, to help the day go smoothly, please:

• Bring snacks, juice, formula, diapers, toys, etc. for your child
• Bring a bag lunch, as we cannot guarantee a lunch break
• If your child has a scheduled medication dose while you will be at the clinic, bring it with you
• Bring your insurance card, NAS form, if applicable, to the department

After Surgery

Parents and caregivers are encouraged to treat their children as normally as possible after surgery. This includes setting limits, disciplining, and offering lots of understanding and tender loving care. A consistent, loving approach gives your child the ability to anticipate their environment and will help your child regain a sense of control and safety. 

Some post-surgical behaviors which one may encounter include wanting to be held more and other attention seeking behavior, withdrawal (being more quiet, reflective), anger, sadness, bad dreams/nightmares, regression (not being able to do some things they could before the hospitalization such as toilet training or reverting to baby talk). It is normal for these behaviors to last for four to six weeks after leaving the hospital. Your child may also have a harder time being away from you (separation anxiety). These are appropriate reactions as your child attempts to work out and cope with the experience and stress of hospitalization. If you have any concerns regarding a particular behavior, speak to your pediatrician, cardiologist, or nurse specialist. 

Wound Care

The incision is covered with special tape called steristrips to keep the skin edges together. It will slowly peel off over the first 7 to 10 days after surgery (or after the first postoperative bath).

Things to remember at home:

• Keep fingers off incision to prevent infection!
• Keep chest covered with T-shirts or bibs to prevent food or saliva from getting on incision.
• Sponge bath only for 7 to 10 days and until suture (black stitches) from chest tubes are removed and healed.
• Once bathing or showering is permitted, clean the incision gently with mild soap and water. Pat dry. Do not rub across incision for 6 weeks.
• Call your cardiologist if the incision has drainage (pus, blood tinged or clear fluid), redness, swelling, edges of incision separate, or any increased pain or tenderness. THIS IS VERY IMPORTANT!
• Small amounts of light pink/red tinged drainage from the chest tube sites can occur - call if it is a large amount, looks like pus, or has a foul smell.

Activity Level and Comfort

• Being up in a chair and walking 4 to 5 times a day helps your child recover. Walking upright is important to promote proper healing of the chest bone.
• For 6 weeks after surgery, your child should not participate in lifting, carrying or pushing heavy objects (including overloaded backpacks greater than 5 pounds), contact sports (baseball, football, jumping, rollerblading, bike riding, monkey bars, gymnastics) or any activity that can cause trauma.
• After 6 weeks, do not restrict your child's activity unless otherwise told to do so by your cardiologist.
• When lifting your child, "scoop" them with one arm behind the shoulders and one under the bottom for the first 6 weeks.
• If helping to a sitting position, do not pull on the arms. Gently support behind the neck/shoulders to a sitting position.
• If your child had a side incision (thoracotomy), encourage arm exercises to prevent muscles stiffness. These include lifting both arms over their head, walking fingers up the wall (the itsy bitsty spider... ) or reaching for objects in front of them.
• Tylenol 1 - 2 times a day in recommended doses is helpful for pain control (PLEASE ENSURE YOU ARE GIVING THE ACCURATE DOSE AND STRENGTH OF TYLENOL). A dose before nighttime sleep is often helpful.
• If pain increases or does not subside, call your cardiologist.

Diet

• Encourage a normal variety of foods. Restrict salt if instructed to do so.
• Encourage good liquid intake.
• Extra protein can help the healing process. Examples include fish, chicken, tofu, milk, cheese, peanut butter, and legumes.

Dental Care

• Dental care remains important even after surgical repair of a heart defect.
• If you child required antibiotics with dental care/procedures/surgeries, continue this until your cardiologist tells you it is no longer indicated.
• For certain heart conditions, antibiotic treatment must continue for your child's entire life.

Immunizations

Your pediatrician or nurse practitioner will monitor when your child should have immunizations. Overall, immunizations should be given at the normal times. After heart surgery, it is recommended waiting 6 to 8 weeks before receiving immunizations.

WHEN TO CALL YOUR PEDIATRICIAN OR PEDIATRIC CARDIOLOGIST

For the first month after heart surgery you should assume that any problem that your child has is related to their heart. Contact your child's cardiologist immediately if your child experiences any of the following problems:

• Incision drainage or new swelling, tenderness, or redness
• Fever greater than 100 F or 38 C
• Difficulty breathing (breathing faster, hard breathing, noisy breathing, shortness of breath)
• Nausea, vomiting, diarrhea, decreased appetite
• Unusually tired/fatigued/pale
• Irregular heart beat (do not check unless instructed to do so)
• Vomiting medications
• Pain that is worsening or does not go away
• Inability to lay flat and breath comfortably
• Any other concerns

This page includes information on the following topics regarding after-surgery care:

•Before Surgery
•After Surgery
•Wound Care
•Activity Level and Comfort
•Diet
•Dental Care
•Immunizations
•When to call

Disclaimer: The information provided here is intended to educate the reader about certain medical conditions and certain possible treatment. It is not a substitute for examination, diagnosis, and medical care provided by a licensed and qualified health professional. If you believe you, your child, or someone you know, suffer from the conditions described herein, please see your health care provider immediately. Do not attempt to treat yourself, your child or anyone else without proper medical supervision.

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