How will they save my babies brain while they do heart surgery?

The brain is what the body is all about and over time there has been a greater and greater appreciation that although the heart could be fixed often the brain suffered sometimes severe damage in the process leading to a poor quality of life for the child. Many new techniques have been developed to try to protect the brain during and after surgery.

Chill it!! Whether the child's heart is stopped during surgery of put on bypass, cooling the brain (literally packing it in ice) as well as the body seems to help the brain survive the surgery better. Quick cooling should be better no? Actually not. One famous heart surgeon in the Boston area was known for both his skill and speed so they would cool the babies down quickly and then warm them up fast. The surgical team was perplexed about why this superior surgeon's babies had more brain damage than his less skilled and slower resident fellows until they discovered the difference was the slow cooling/rewarming necessary for the slower resident surgeons.
Avoid anemia! anemia is low blood counts particularly the red blood cells that carry the dissolved  oxygen to the brain. The bloods job is to carry the oxygen around the body and just the right amount is just that - just right. Too much blood and it thickens and clots blocking blood getting to the brain( a stroke) and too little and the brain is short on the oxygen that it loves. The babies blood count will be carefully monitored to keep it just right.
Prevent air from getting where it shouldn't be!  Blood carries dissolved oxygen but air bubbles - like those in a fish tank are much too big and get stuck in the small blood vessels leading to the brain. The tiny strokes that these can cause can lead to long term problems with learning, speech and intellect. The bubbles can be microscopic and can come from anywhere- the bypass machine, IV tubing, or the heart that is open to the outside air as the surgeon operates. To avoid this some surgeons actually pour carbon dioxide (think of the cloud of smoke at the last KISS concert you went to) over the heart as they work on it. They will also have someone look with a special scope called a echo at the babies heart to make sure the bubbles are gone before they reconnect the heart and get it pumping again.

Watch the brain during surgery! this is done with a variety of special instruments. Transcranial dopplers that can listen to the blood flow to the brain and EEG that can look at the electrical activity of the brain.

Monitoring chemicals in the blood after surgery. close monitoring of the acidity of the blood (pH), oxygen levels and blood pressure can ensure that the brain is getting the best possible environment to recover

Home monitoring: despite all of this about 1/3 of babies die after the first surgery before they get the second surgery. This has been greatly reduced in some centers by having home monitoring program that acts like an early warning system. Parents are supplied with an Oximeter to check the babies oxygen levels every morning and a scale to weigh the baby to look for early heart failure. Anything that is abnormal is called to the heart team immediately otherwise they check in by phone every two weeks.

Congenital heart disease

As more and more of the children coming from China are special needs there is a great number of them that were born with problems of the heart. It is very hard to know how bad the problem is before getting the baby home and what will be needed to fix it. The initial surgery is often done in China but often a series of surgeries are needed to further rearrange the plumbing until the child is grown. Currently the survival of these children is around 80% from birth for all types of these heart problems as a whole.
So what are the problems if my baby has one of these congenital heart problems? 
Like everything there is good and bad news. The bad news is that when these babies have had scans done of their brains before surgery about 20% of them already have some damage that was done by the heart problem even before birth. The good news is that in long term studies of these children after the surgeries, they seem to do fine although their IQ's are slightly lower than other children. The other important factor is that the more well off economically and educationally the babies' families are the better they do probably because their families can access more help for the babies.
How is the heart built and why do these defects cause so much trouble? 
To get an idea of the hearts job think of the face of  a clock. At the top or 12 O'clock position is the right side of the heart which pumps blood, blood without oxygen toward 3 O'clock. At 3 O'clock are the lungs which add dissolved oxygen to the blood and send it along to 6 O'clock where the left side of the heart sits. The left side is the workhorse of the heart and pumps the blood now rich in oxygen to the 9 O'clock position for the rest of the body including the brain, kidneys, stomach, arms, legs. The brain loves oxygen and all the other organs are there to keep the brain well fed with oxygen. No oxygen and the brain dies. That is the basic plumbing of the body.
Now let's get a little more accurate detail. If you take your fingers and pinch the 12 O'clock down to the 6 o'clock  you end up with a figure of 8. This is really what happens because the left and right parts of the heart are directly next to each other but the blood  normally can't get from one side to the other. If you throw in a hole between the two sides or remove the 12 o'clock position altogether you see that the oxygen rich blood gets mixed with the other blood and gets pumped out to the body. Sometimes both sides of the figure 8 don't connect at all so there is only bad blood on one side and good blood on the other with only a tiny hole connecting the two sides. This is why the surgeries are so complex and take multiple steps because the plumbing can get really crazy!
So how do they work on a pumping heart anyway? 
They either stop it and work fast or they bypass the heart and let a machine do the pumping. This is called cardiopulmonary bypass and is done by putting a tube in at 11 O'clock and taking all the blood out before it gets to the right side of the heart and running it through a machine where they add the oxygen that it would normally get from the lungs at 3 O'clock. It is then run back into the body at 7 O'clock thus bypassing the heart altogether. The body and most importantly the brain get the oxygen it needs and the surgeon can work on the heart without it pumping away. 

On being a tourista

I love to travel. One of the great temptations for me during the trips to China was to try to see as much as I could and to eat as much local food as possible. The problem wa,s I wasn't really in China to travel. I was in China to form a family! Each day I would wake up and tell myself  "I am not here as a tourist". That was followed by the most difficult thing a man can do- try to think how to help my wife out with taking care of the baby. The temptation to go to the exotic Beijing market (where you can get everything from fried scorpions on a stick to sheep's penis) was almost too much but i can proudly say I said no and just had a scorpion delivered to my room by friends in our travel group.
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The point is that it takes time to effectively bond to your child and the best way to do that is to not be a tourist but rather be a parent, having lots of down time: time hanging out in the hotel room playing, trying out the squeaky shoes in the hotel lobby or just playing in the park.

This also applies to when you get home. Try as much as possible to keep your life simple and not foo full of activities and events. This wasn't easy for us when we arrived home to two college students, a girlfriend and a boyfriend and Christmas, but down time was important the help our daughter adjust to her new forever world. Daycare unless absolutely neccesary, preschool, dance, gymnastics you name it--is best left for a few months down the road once your child has become comfortable with her new home and family.

P.S. the scorpions just taste like salty potato chips (see picture) but I passed on the penis- probably taste's like chicken anyway.