A Week in Congenital Cardiac Surgery

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Have you ever wondered what congenital cardiac surgery involves? I definitely have! Being interested in cardiothoracic surgery, this was the subspecialty I had never experienced.

During my paediatrics placement, I was fortunate to have the opportunity to contact one of the congenital cardiac surgeons, and spend a week in the department. Here is an insight into my day-to-day, based around the learning record I wrote at the time!

Day 1

8.00. Arrived to the hospital. Changed into scrubs. Got lost trying to find out the theatre. The usual story!

8.15. Team brief to start the day! At that time (or a bit later, depending on the day) the team meets to discuss the case for the day. Just before, I introduced myself to the cardiac registrars, and also the anaesthetist who showed me around and offered to explain me more aspects of the procedure (in cardiac surgery, the anaesthetist should be your best friend – at least in my experience!)

8.30. Catch up with the other registrar in their ward round (who seems to take them all around the hospital – ICU, PICU (paediatric ICU), adult cardiac ward, paediatric cardiac ward…! (Congenital cardiac surgery deals with both adult and paediatric patients!).

9.30. Join in theatre. Preparing the patient usually takes a while! The procedure was the surgical replacement of a RV (right ventricle) to PA (pulmonary artery) conduit.

….

Lasted all day! It was fascinating, and I definitely learnt a lot on the first day, both on key aspects of the procedure, and the physiopathology behind it. Afterwards, I went with the surgical registrar to PICU, where I learn more about the monitoring of postoperative patients and the possible complications.

Tip: Ask other members of the surgical team for help if you have any questions! The perfusionist really helped me understand the mechanism of the cardiopulmonary bypass machine, and the anaesthetist was constantly asking questions and explaining different related topics!

Day 2

8.00 This time I did not get lost! (Pure luck)

8.15 Team brief. The procedure planned was a pulmonary valve replacement and VSD (ventricular septal defect) direct closure. After the team brief, I went for breakfast and a very much needed coffee with the registrar. I think it is always wonderful to be in such a welcoming team!

9.30 Another full day case starts. Generally, as a student, you can take small breaks, although I often feel compelled to stay for the whole procedure (fear of missing out?).

Tip: There are three things essential to spending a day in theatre: good sleep, good food (and keep hydrated!) and good shoes. I discovered the last one, even though it seems quite evident, a bit late). Cardiac surgery usually involves a lot of standing (a full day of standing to be precise).

Day 3

8.15. Team brief. While in the procedures I had seen previously the patients were in their teens, this one was a ToF Repair (Tetralogy of Fallot) in a four-months old baby. Having read quite extensively on the Tetralogy of Fallot and finally observing a surgery to repair made it a memorable day!

8.30. MDT meeting. The emphasis on the multidisciplinary team in congenital cardiac surgery is really evident, since patient management is based on interdisciplinary decision-making. What really caught my attention was the ethical questions discussed (definitely will write more on this one day soon!)

9.30. I had the chance to see the consultant surgeon (whom I initially contacted to have this opportunity) in theatre! And – best of all – I was allowed to scrub in, which I was not expecting at all.

I went home in the afternoon to tidy my notes and search more on everything I saw and learnt in surgery that day!

Tip: Take a notebook with you at all times, it is useful to jot down any questions you have or things you learn or want to read more extensively after the procedure. Otherwise, it is quite easy to forget!

Day 4

8.30. Not all days are theatre days! On Thursday I chose to have more experience in the wards, especially because I wanted to improve my clinical skills – auscultating and recognising abnormal heart sounds and performing a full paediatric cardiac examination. I joined the ward round, and was fortunate that one of the registrars was really keen on teaching.

11.00. After the ward round, a tea break with the team, and went with the junior doctor as he completed the jobs needed to be done in the morning.

13.00. After lunch time, I spent more time on my own, talking to patients and their families. There was so much to learn, from the preoperative and postoperative management, to the impact on the family of the patient.

Tip: Ask the doctors to point out patients you could examine or take a history from. In general, be proactive, it is what will make you day a fruitful learning experience!

Day 5

8.30. Ward round in the paediatric cardiac ward (same as the previous day), followed by ward work (examination of patients, cannulas, etc).

11.30 Time for some echocardiography! I was explained the basics of interpretation and observed the echo of a patient with a double inlet left ventricle (homework for the reader: read more on this!). Also got teaching on rarer cardiac anomalies, such as Ebstein’s anomaly.

13.30 Bedside teaching with my clinical tutor in paediatrics. It was such a coincidence that he chose for that tutorial to focus on paediatric cardiology – and it definitely helped me to reinforce my knowledge.

Some of the patients we saw:

  • A baby with Trisomy 21 and cardiac complications (do you know what is the most common cardiac anomaly in this syndrome? It is worth finding out!)
  • A teenager recovering from cardiac surgery, precisely the one I saw on Monday. Good news – she was recovering very well!
  • Cardiac examination of a baby with acyanotic congenital heart disease.

Tips: try to understand well the pathophysiology of different conditions – and this applies to many other fields! One of the registrars made me draw a simple diagram of the heart to explain different heart conditions, it was useful, and I recommend doing this for a better understanding.

I hope you enjoyed reading! Sometimes it is hard to get exposure during placement in specialties such as congenital cardiac surgery. My suggestion is to directly contact one of the doctors of the team, you might have to try several times or different people, but I assure you will eventually find someone keen to give you an opportunity!

What about you? Have you been in any paediatric surgery?

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