Today I’m here to talk to our congenital heart disease friends or parents of children with congenital heart disease about the problem of postoperative murmurs, which is a problem that confuses many people. Because in the clinic and in practice, we often encounter parents of children with nervous faces asking: Dr. Wu, my child has finished the heart defect repair, and the last review said that there is no problem with the heart and the defect has been repaired, how come today the doctor heard a heart murmur again during the examination, is the heart not repaired? In serious cases, they even have doubts about the explanation of the attending doctor. What’s more, because of this problem, they repeatedly visited different hospitals, wasting their time and energy, and consuming the already tight medical resources. In response to this problem, I think an important issue one is the current busy clinical work of cardiac surgeons, preoperative account or called doctor-patient communication is not enough, so it is very necessary to popularize the issue of postoperative heart murmur: which precordial disease will exist after surgery murmur, what is a physiological murmur, simple precordial disease will not appear after surgery murmur, etc.. A. Congenital heart disease in which a heart murmur still exists after surgery Farrow’s tetralogy of Fallot is the most common clinical cyanotic precordial disease, and almost 100% of murmurs can be heard after surgery in this disease, but how is this murmur produced? This is because in Farrow’s tetralogy of Fallot, the right ventricular hypertrophic muscle has been surgically removed, unblocking the right ventricle to the pulmonary artery, so that when the blood flows through the right ventricle where the muscle has been cut, a murmur will appear due to local blood flow irregularities or eddy currents. In some children with severe tetralogy of Fallot, the preoperative murmur is very mild or inaudible, but after surgery, the murmur can be heard, which is a normal postoperative murmur. This is a normal post-operative murmur, and you should not worry about it. With tetralogy of Fallot, it extends to all congenital heart diseases with right ventricular outflow tract stenosis, those that need to be unblocked or those that need to be connected to the heart and large vessels with patches or tubes, including pulmonary valve stenosis, double outlet of the right ventricle, pulmonary atresia, etc., and those with complex congenital heart disease staged surgery all have post-operative heart murmurs. However, you should pay attention: if your child has residual leakage of septal defect, residual obstruction of the right ventricular outflow tract, and the transvalvular pressure difference is greater than 50 mmHg or half of the systolic pressure, this is not a normal postoperative murmur and needs to be re-evaluated or surgically treated. Second, will a murmur occur after surgery for simple precordial disease? For the vast majority of simple precordial diseases, such as ventricular septal defect, atrial septal defect, and arteriovenous catheterization, murmurs are not audible after surgery. However, it is not absolute. For large defects, the murmur may still exist after surgery due to the use of patches during surgery, which include pericardial patches, polyester patches, etc. and normal myocardial tissue is different, and blood flow through the patches due to rapid blood flow impact, so that the murmur may still exist after surgery. Therefore, the murmur does not necessarily disappear after ventricular septal defect surgery. When a murmur appears, as long as the heart ultrasound is reviewed and there are no structural problems, do not worry about it, and do not repeatedly visit the clinic for consultation and be worried all day long. However, if the ultrasound suggests the presence of a residual shunt of the defect or recanalization of the arterial catheter, it is necessary to provide specific guidance according to the situation. Generally residual leak less than 3mm and arterial catheter recanalization less than 2mm are likely to heal after surgery and can be closely observed clinically with a follow-up ultrasound every 3-6 months. If the residual leak is greater than 3mm and the arterial catheter is greater than 2mm, timely surgery is recommended and cannot be taken as a fluke. At present, with the widespread use of intraoperative esophageal ultrasound, the incidence of postoperative residual leak in simple precordial disease is significantly reduced, and even if it occurs, it can be promptly remedied intraoperatively. Third, physiological murmur Many children can hear a heart murmur during physical examination, but the ultrasound does not reveal the presence of congenital heart disease; this murmur is also called a functional murmur, which has no pathological significance. The cause may be related to the vibration of the high velocity blood flow in the heart against the heart or the pulmonary arteries. The murmur can be heard through the chest wall in children because of its thinness. This murmur is usually soft and varies with position, sometimes very soft and sometimes more pronounced. This murmur is much less of a concern for parents. This explains why many simple congenital heart disease murmurs are heard on physical examination after surgery, which means that in addition to the murmur of the blood flow impact patch mentioned above, there may be a physiological murmur that exists in itself. To sum up, in fact, many congenital heart disease murmurs will not disappear after surgery, but for children with congenital heart disease, if the child is found to have a heart murmur by other doctors after a physical examination at school or a cold, do not panic, you can go to a hospital with conditions to review the cardiac ultrasound, to exclude the possible residual leakage of the heart or other combined problems, it means that the murmur is a physiological murmur or If the murmur is physiological or functional, it will not affect the function of the heart or the child’s activity level. However, if the child has a residual leak, residual stenosis, or arterial catheter recanalization, the child should be examined by a specialized hospital in a timely manner so that timely treatment can be obtained.