Few parents welcome the news that their child must undergo surgery.
Their concerns often run the gamut: Will my child be O.K.? Will my child be in a lot of pain during the recovery? How noticeable will the scar be?
These concerns are natural and protective, and speak to the very nature of what it is to be a parent.
At Riley Hospital for Children at Indiana University Health, Indiana's only comprehensive children's hospital, experts are working every day to ease parents' concerns about surgery. Riley Hospital for Children Pediatric Surgery at Indiana University Health pediatric surgeons in every specialty are at the forefront of developing and utilizing new surgical techniques while providing the outstanding outcomes Riley Hospital for Children at IU Health is known for.
The movement is called "minimally invasive surgery," which includes the use of special tools to perform procedures with almost no incision at all and traditional surgeries utilizing the smallest possible incisions.
Minimally invasive techniques have revolutionized care for children with heart defects. Some defects that only a few years ago would require open heart surgery can now be treated with catheter-based procedures. A catheter is a tube that is inserted through an artery or vein, usually in the groin, and navigated up to the heart.The catheter allows doctors to see defects and make repairs with virtually no pain to the patient.
Just ask 12-year-old Andrew James. Unexplained pain, redness and swelling around his ankle last summer raised a red flag with his parents and his pediatrician. She recommended Andrew undergo tests to rule out rheumatic fever, which can damage the heart and affect its function. One test, called an echocardiogram, showed no signs of rheumatic fever. However, it did reveal Andrew had a half-inch hole between the upper chambers of his heart.
"You think, oh my gosh - how can this be?" says his mother, Elizabeth James. "But you're so thankful that they found it."
The James family was presented with two options to repair the hole in Andrew's heart: open heart surgery, or a relatively new procedure, which uses a catheter to place a patch over the hole and restore normal blood flow. Andrew's pediatrician urged the family to take him to Riley at IU Health for evaluation by IU School of Medicine pediatric cardiologist Dr. Mark Hoyer, an innovator nationally in the minimally invasive technique and, by far, the most experienced in the state.
Dr. Hoyer found Andrew to be an ideal candidate for the new procedure. The hole in Andrew's heart was closed on November 26. Andrew went home the next day, and the following day enjoyed Thanksgiving festivities with his family.
"I was really surprised that I felt good so soon," Andrew remembers. "We just feel so lucky," says his mom. "When you have two kids who have always been healthy, then one has a diagnosis like this - it's scary. We're just counting our blessings. He came through it so well." For babies and children with heart defects that do require open heart surgery at Riley at IU Health, the surgeon's primary goal is doing the best repair and having the best possible outcome for the child. But by utilizing a limited incision technique called a partial sternotomy, Riley Hospital for Children at IU Health's team of pediatric cardiovascular surgeons can perform some of the most complicated open heart procedures through incisions that are around 1½ inches long, minimizing surgical trauma to the bone and muscle around the patient's heart.
"It creates much more stability of the sternum, which is the bone that connects all of your ribs in the center of your chest. This greatly diminishes surgical trauma to the entire chest," explains Dr. Mark Turrentine, cardiothoracic surgeon and IU School of Medicine associate professor of surgery at Riley at IU Health. "Patients heal faster. The scar is much smaller, much more cosmetic and the child is much more comfortable after surgery. It makes a difference."
With open heart surgery to correct congenital defects often occurring when children are quite young, by the time they're old enough to understand what the surgeons have done to make them well, there's little evidence of it.
"This approach certainly increases the difficulty of open heart repairs to some extent because you're working through a smaller space. We have to become accustomed to working with less visualization and yet remain exceedingly vigilant about our surgical technique," says Dr. Turrentine. "In the end, families are very appreciative."