[Show abstract][Hide abstract] ABSTRACT: Background:
Intricate repairs performed for adult mitral valve disease may not be feasible in young children because of their small annulus, future growth and also fragile tissue.Methods and Results:Mitral valve repair was performed in 51 patients (1980-2011) aged younger than 5 years. The median follow-up was 3.0 (maximum, 24.2) years. Commissural annuloplasty technique was performed solely in 19 of 37 patients with coexisting cardiac disease. In 2 patients, Alfieri's edge-to-edge technique was used. Repairs for the remaining 30 patients used one of the following procedures: commissural closure (8), closure of the accessory cleft or hole (7), sliding leaflet technique (6), artificial chordal placement (6) and chordal shortening technique (3). There were 3 deaths. The postoperative degree of mitral regurgitation was mild or less in 41 patients (80.4%); 9 patients required reoperation for mitral regurgitation or stenosis. Freedom from reoperation for patients with isolated mitral regurgitation and those with other congenital heart disease at 10 years was 91.7±68.0% and 68.4±9.4%, respectively. Actuarial survival was 97.0±3.0% and 85.1±9.7%, respectively.
Excellent survival rates were achieved after mitral valve repair in patients younger than 5 years. The incidence of both reoperation and significant regurgitation was acceptable.
Preview · Article · Nov 2015 · Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: Background:
There is currently a well-established network for the allocation of donor organs for transplantation in Japan, and emergency patients are often transported by the "Doctor Helicopter". However, interhospital transfer of patients, which can require aircraft with specialized equipment, depends on arrangement by each responsible hospital.
Methods and results:
Since 2009 there were 41 interhospital aviation transfers of pediatric patients with intractable cardiac or airway diseases seeking surgical treatment at Sakakibara Heart Institute. Of these, 22 were newborns, 21 were on continuous drip infusion and 14 on mechanical ventilator support. In 15 cases (36.6%), a commercial airliner was used, with the remaining using chartered emergency aircraft (eg, local fire department helicopter, Self-Defense-Forces of Japan and the Doctor Helicopter). The median transfer time was 239 min for commercial airliners, 51 min for chartered aircraft departing directly from the referring hospital and 120.5 min for chartered aircraft departing from a nearby location. The efficiency of the transfer exemplified by the percentage of the time on board the aircraft was significantly lower for commercial airliners compared with chartered emergency aircraft.
Further efforts and cooperation with government are required to obtain geographically uniform availability of carriers with optimal medical equipment to improve pediatric patient outcomes.
Preview · Article · Nov 2014 · Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: Objective:
Total cavopulmonary connection (TCPC) is rarely performed for a functional single ventricle in children with Down syndrome; therefore, the postsurgical outcomes are not well known. We evaluated mortality and related factors after TCPC in children with Down syndrome.
Between January 2004 and March 2010 we identified 8 patients with Down syndrome among 235 patients who had undergone TCPC. The preoperative clinical course, preoperative data, and postoperative clinical course were evaluated. In addition, clinical parameters and postoperative clinical course were compared between children with Down syndrome (n = 8) and a non-Down syndrome group (n = 227).
The median age at the time of TCPC was 4.1 years (range, 3.4-5.5 years), and the preoperative mean pulmonary artery pressure was 13.9 ± 1.81 mm Hg. We observed respiratory complications in 2 patients, surgical site infection in 3 patients, and chylothorax in 2 patients. No significant difference was observed in preoperative data and mortality rate (1 of 8 patients [12.5%] in the Down syndrome group; 5 of 227 patients [2.2%] in the non-Down syndrome group) between the groups of children with and without Down syndrome. However, when the postoperative clinical course was examined, the durations of intensive care unit stay (P = .009) and hospital stay (P = .007) were found to be significantly prolonged in the Down syndrome group.
Patients with Down syndrome tend to show prolonged recovery after TCPC. However, as opposed to previous reports, the mortality rate of patients undergoing TCPC is lower with no significant difference from that of children without Down syndrome.
No preview · Article · Mar 2013 · The Journal of thoracic and cardiovascular surgery
[Show abstract][Hide abstract] ABSTRACT: The use of implantable cardioverter defibrillator (ICD) therapy for congenital heart disease (CHD) has been increasing, but few studies have reported on the efficacy of ICD therapy in Japanese CHD patients.
Twelve CHD patients (median age, 35 years) with first ICD implantation were examined. Median follow-up duration was 2.9 years. Demographic information, implant electrical parameters, appropriate and inappropriate discharge data and complications were recorded for all implants from 2003 to 2010.
Implant indication was primary prevention in two patients and secondary prevention in 10. Overall four patients received one or more discharges; three patients (25%) with secondary prevention received nine appropriate discharges. Inappropriate discharge attributed to sinus tachycardia occurred in two patients (16.7%). Only one patient experienced the late complication of skin erosion at the generator implantation site.
Patients with CHD experienced significant rates of appropriate discharges and lower complications. But given that the indications of ICD implantation were mostly for secondary prevention, the ratio of appropriate shocks might be lower than in previous studies. In the primary prevention patients, the benefit of ICD was not clear because no appropriate discharges were seen during follow up. Although ICD implantation for CHD is beneficial for preventing sudden cardiac death, careful decision making and a large, long-term prospective study is required for the determination of the efficacy of ICD therapy in Japanese patients with CHD.
No preview · Article · Dec 2011 · Pediatrics International
[Show abstract][Hide abstract] ABSTRACT: Presently, there are wide variations in cardiac anatomies requiring single ventricular palliation and these variations may have an impact on the incidence of atrioventricular valve regurgitation.
In all, 363 patients underwent single ventricular palliation (1978 to 2008). Hearts were first classified into single right ventricle (156), single left ventricle (140), and two ventricles (63); and secondly into single mitral (90), single tricuspid (64), two separate valves (110), and common atrioventricular valves (95).
The incidence of atrioventricular valve regurgitation and the necessity of repair were the highest with common atrioventricular valves, followed by tricuspid and mitral valves (p < 0.0001). The success rate (postoperative regurgitation of mild or less) of repair was similar (p = 0.9800). Estimated survival for patients having moderate or greater atrioventricular valve regurgitation was similar to the rest of the patients (p = 0.8705). Patients were more likely to have progressive mitral regurgitation in the presence of both mitral and tricuspid valves, compared with single mitral valve (p = 0.0207). There were 2 patients who had severe mitral regurgitation; both had a nonsystemic left ventricle isolated from the circulation by malposition of the great arteries and restrictive/remote ventricular septal defect. In contrast, coexisting mitral valves reduced the incidence of potential tricuspid regurgitation (p = 0.0012).
If performed properly, atrioventricular valve repair may neutralize the risk of regurgitation regardless of the valve morphology. The effort to incorporate the mitral valve into the systemic circulation may be important to reduce tricuspid regurgitation. The effort to decompress a nonsystemic left ventricle, if present, may be important to avoid unfavorable ventricular interactions on the mitral valve.
No preview · Article · Jul 2011 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: The effect of carvedilol on heart failure (HF) in patients with a functionally univentricular heart (UVH) remains unclear.
Carvedilol was used to treat HF in 51 patients with a UVH, classified into 3 groups: after the Fontan operation (F), after the bidirectional Glenn operation (G), and patients who had not undergone Fontan or Glenn operation (NF). Carvedilol therapy was started at a mean age of 10 ± 12 years (range: 1 month to 34 years). The initial and maximum doses of carvedilol were 0.04 ± 0.03 and 0.42 ± 0.29 mg · kg(-1) · day(-1), respectively. After a mean follow-up of 11 months, the cardiothoracic ratio improved from 60 ± 8 to 58 ± 8% (P<0.01), and the dosage of furosemide was reduced from 1.4 ± 0.9 to 0.7 ± 0.7 mg · kg(-1) · day(-1) (P < 0.01). The ejection fraction also improved from 35 ± 12 to 40 ± 11% (P < 0.05), and this improvement was prominent in the F group (from 35 ± 15 to 45 ± 9%; P < 0.05). Clinical signs, symptoms, and New York Heart Association functional class also improved.
Carvedilol may play an important role in treating HF associated with a UVH.
No preview · Article · Mar 2011 · Circulation Journal
[Show abstract][Hide abstract] ABSTRACT: An additional malformation of the atrioventricular valve is occasionally encountered in patients with complete atrioventricular septal defect, and this may compromise accurate correction.
We reviewed 138 patients undergoing complete repair with two-patch technique between 1992 and 2008. The mean age was 7.1 + or - 8.3 months, and the mean body weight was 5.1 + or - 2.1 kg. Preceding pulmonary arterial banding was performed in 23 patients.
The operative record delineated additional malformations of the atrioventricular valve that posed difficulty in positioning the ventricular septal patch and in accurately approximating the cleft in 45 patients. Of them, four types (n = 40) were associated with increased incidence of postoperative left valvular problems (moderate or worse regurgitation or stenosis). These included abnormalities of the papillary muscles that accompanied hypoplastic mural leaflet or incomplete opening of one commissure in (n = 15; p = 0.0054), dense insertion of the chords of the superior leaflet that obscured the right side of the ventricle septal crest in (n = 13; p = 0.0004), double orifice valve (n = 7; p = 0.0225), and severe length disparities of the cleft that resulted from either disproportional size of superior against inferior leaflets or redundant chord supporting the left extremity of one of these leaflets (n = 5; p < 0.0001). Neither greater age at operation (more than 6 months) nor preceding pulmonary arterial band reduced the incidence of left valvular problems in the malformation group.
An individualized technique is required to maintain coaptation of the atrioventricular valve, but in many cases, they are not completely correctable. Deferring complete repair by placing a pulmonary arterial band did not reduce left valvular problems.
No preview · Article · Aug 2010 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: There have been few reports describing the use of carvedilol in children or patients with congenital heart disease. Therefore, its optimal regimen, efficacy, and safety in these patients have not been adequately investigated. Subjects were 27 patients with two functioning ventricles, for whom carvedilol was initiated (from December 2001 to December 2005) to treat heart failure. All patients had failed to respond to conventional cardiac medication. They consisted of 12 males and 15 females, aged 23 days to 47 years (median age: 2 years). Heart failure due to ischemia (myocardial infarction, intraoperative ischemic event) or due to myocardial disease (cardiomyopathy, myocarditis), and heart failure with atrial or ventricular tachyarrhythmia represented 70% of all cases. Carvedilol was initiated at a dose of 0.02-0.05 mg/kg/day, which was increased by 0.05-0.1 mg/kg/day after 2 days, 0.1 mg/kg/day after 5 days, and 0.05-0.1 mg/kg/day every month thereafter with a target dose of 0.8 mg/kg/day. This study retrospectively assessed the efficacy and adverse reactions based on changes of symptoms, cardiothoracic ratio (CTR), left ventricular ejection fraction (LVEF), and human atrial natriuretic peptide (hANP)/b-type natriuretic peptide (BNP) blood levels. The mean follow-up period was 10.2 months (range: 1-46 months). Twenty-six (96.3%) patients showed improvement in symptoms and were discharged from the hospital. However, the remaining one patient failed to respond and died. Significant cardiovascular adverse reaction was seen in none of the patients. The mean CTR decreased from 61.8% +/- 5.3% before treatment to 57.6% +/- 7.4% after treatment (P < 0.05, n = 25), and the mean LVEF improved from 41.4% +/- 23.1% to 61.1% +/- 10.1% (P < 0.05, n = 10), respectively. Mean hANP and BNP levels showed a decrease from 239.1 pg/ml to 118.3 pg/ml and a significant decrease from 437.9 pg/ml to 120.5 pg/ml, respectively (P < 0.05, n = 10). Improvements in these data were also demonstrated when analyzed individually among the pediatric group (aged younger than 18) and the congenital heart disease group. Initiation of carvedilol at a lower dose with more gradual dose escalation, compared with previously reported regimens, might have efficacy with low incidence of adverse effects in pediatric patients and patients with congenital heart disease. Carvedilol may be effective in treating heart failure in children due to ischemia, myocardial disease, and complicated by tachyarrhythmia.
Full-text · Article · May 2009 · Heart and Vessels
[Show abstract][Hide abstract] ABSTRACT: To assess outcomes of surgical repair of aortic arch obstructions with associated cardiac anomalies, we reviewed our institutional experience.
Between 1995 and 2005, 90 consecutive patients with interrupted aortic arch (n=25) or coarctation of the aorta (n=65) and cardiac anomalies underwent biventricular repair. Coexisting cardiac anomalies included ventricular septal defect (VSD, n=69), transposition of the great arteries (n=11), Taussig-Bing heart (n=4), double-outlet right ventricle with subaortic VSD (n=1), atrioventricular septal defect (n=4), and an aortopulmonary window (n=1). Arch reconstruction was accomplished by a subclavian flap aortoplasty in 12 patients, end-to-end anastomosis in 23, and end-to-side anastomosis in 55.
The overall early and late mortalities were 5.6% (n=5) and 6.7% (n=6), respectively. The overall survival was 87%+/-3.7% at 10 years. Mortalities for VSD and for complex cardiac anomalies were 4.4% and 7.8%, respectively. Univariate analysis identified types of associated cardiac anomalies as a predictor for death, with the survival of patients with VSD significantly better than the other complex cardiac anomalies (p<0.05). There was a trend for single-stage repair to be associated with lower mortality compared with staged repair (p=0.06). No patients undergoing end-to-side arch reconstruction had a recurrent obstruction.
The type of associated intracardiac anomalies with arch obstruction influenced postoperative outcomes. Although both approaches could achieve good results, our data suggest that single-stage repair for arch obstruction with VSD may be associated with better survival, and is therefore recommended.
No preview · Article · Apr 2009 · European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: The objective of this study was to investigate the results of handmade polytetrafluoroethylene trileaflet conduits implanted in the pulmonary position since 1997.
One hundred thirty-nine patients underwent pulmonary reconstruction with a polytetrafluoroethylene conduit. Conduit function was investigated by means of review of serial echocardiographic studies.
Mean age and body weight were 12.7 +/- 12.0 years and 30.9 +/- 20.6 kg. Mean size of the conduit was 21.0 +/- 3.8 mm (12-28 mm). The z score of the conduit was +0.5 +/- 0.8 for patients older than 15 years (n = 43), +1.2 +/- 0.7 for patients 5 to 15 years old (n = 48), and +2.4 +/- 0.5 for patients younger than 5 years (n = 48). Conduits were used for the Ross procedure in 21 patients and for repair of complex congenital heart disease in 118 patients. There were 3 (2.2%) in-hospital deaths and 1 late death. Four patients required conduit explantation because of pulmonary artery distortion at a distal anastomotic site (interval, 1.2 years), infection of the polytetrafluoroethylene valve (interval, 1.6 years), midportion angulation of the conduit (interval, 4.9 years), and conduit compression by the ascending aorta (interval, 5.4 years). Estimated freedom from conduit explantation was 88.0% +/- 6.8%, and pulmonary insufficiency was less than or equal to mild in 75.0% at 10 years. All valves maintained their motion, and the mean estimated pressure gradient across the conduit was 19.6 +/- 11.9 mm Hg at 5 years and appeared to reach a plateau thereafter. The pressure gradient across the conduit was 14.2 +/- 8.0 mm Hg at 3 years (P = .0127) and 18.1 +/- 7.5 mm Hg at 7 years (P = .0208).
Polytetrafluoroethylene conduits represent a valid option and reliable alternative to homograft and xenograft implantation for pulmonary reconstruction.
No preview · Article · Feb 2009 · The Journal of thoracic and cardiovascular surgery
[Show abstract][Hide abstract] ABSTRACT: Cardiopulmonary bypass may cause acute lung injury and can seriously affect postoperative outcome, especially in younger patients.
A synthesized neutrophil elastase inhibitor, sivelestat sodium, may be most effective when used during cardiopulmonary bypass.
After anesthesia induction, sivelestat (2 mg/kg/h) was given to the SS group (n=7), and 0.9% saline solution to the placebo group (n=7). Piglets were placed on hypothermic cardiopulmonary bypass and subjected to myocardial ischemia (2 h) induced by cold
crystalloid cardioplegia. At 24 h after surgery, PaO2/FiO2 ratio and alveolar-arterial oxygen difference were significantly better in the SS group (379.1±93.9 mmHg and 250.5±89.3 mmHg)
than the placebo group (232.4±105.3 mmHg, and 378.3±90.8 mmHg, P<0.05). Interleukin-8 level in the epithelial lining fluid was above the lowest standard in 6 out of 7 (4.5, 12.9, 24.6, 27.7,
37.7, and 159.8; mean=44.5±57.6 g/l) in the placebo group, and in 2 out of 7 (36.1 and 67.8 g/l) in the SS group (P<0.05). The median histological score of acute lung injury in the harvested lung was 3 (2–5) in the placebo group and 1 (1–5)
in the SS group (P<0.05). Intraoperative administration of sivelestat effectively reduced neutrophil induction and activation in the lung and
improved oxygenation after cardiopulmonary bypass in a piglet model.
Preview · Article · Aug 2008 · Interactive Cardiovascular and Thoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Bilateral pulmonary artery banding is considered an option for initial palliation in high-risk patients with hypoplastic left heart syndrome or related anomalies. However, there are potential interim morbidities, including ductal constriction, compromised growth of the ascending aorta, and pulmonary artery stenosis at the banding site. In addition, there are still controversies regarding the optimal timing and choice of the second-stage operation.
Between February 2003 and October 2005, twelve high-risk patients with hypoplastic left heart syndrome or related anomalies underwent bilateral pulmonary artery banding. An atrial septal defect was created simultaneously when the septum was intact or the defect was restrictive. After the procedure, intravenous prostaglandin E(1) was continuously administered.
The median weight was 3.0 kg (range 1.8-3.6 kg), and the median age was 16 days (range 0-27 days). Atrial septum defect creation was performed simultaneously in two patients. Ten of the twelve patients were discharged from the hospital. One patient died of progressive multiple organ failure and another patient died of cerebral hemorrhage. Eight patients developed various degrees of ductal constriction and required dose adjustment of prostaglandin E(1). Two patients underwent ductal arteriosus stent placement: one was unsuccessful owing to the size mismatch between the stent and the ductus. The diameter of the ascending aorta remained unchanged until the time of the second-stage operation, except in two patients who had a sufficiently sized aorta at the time of pulmonary artery banding. Pulmonary arterial branch stenosis developed at the banding site in three patients. At the time of the second-stage operation, the Norwood procedure was performed in seven patients, biventricular repair in two, and Norwood plus Glenn procedure in one.
Bilateral pulmonary artery banding is an option to salvage high-risk neonates with hypoplastic left heart syndrome or related anomalies. However, it is associated with high interstage morbidity, and patients may benefit from early conversion to the Norwood operation.
No preview · Article · May 2008 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: There is a paucity of information regarding appropriate management of children with Down's syndrome and a functional single ventricle. We report the results of bidirectional superior cavopulmonary shunts in six patients with Down's syndrome with a functional single ventricle.
Between January 1991 and December 2004, we identified six patients with Down's syndrome among 263 who had undergone bidirectional superior cavopulmonary shunts (BCPSs). There were four males and two females. The age at BCPS ranged from 1 to 12 years (mean 4.3 +/- 3.9 years), and body weight varied between 8.2 and 29.4 kg (mean 13.8 +/- 7.8 kg). All six patients had an unbalanced complete atrioventricular septal defect, with right ventricular hypoplasia present in five and left ventricular hypoplasia in one.
There were no operative deaths, but one case required takedown of the BCPS. Except for this case, postoperative courses were generally uneventful. The median duration of follow-up was 46 months (range 12-80 months). Only two of five survivors after BCPS underwent a subsequent Fontan procedure, and one of these patients died of pulmonary hypertension post-operatively. The remaining three patients appeared to have significant risk factors for the Fontan procedure due to severe common atrioventricular valve regurgitation or persistent pulmonary vascular obstructive disease, including one who has completely dropped out from the Fontan track.
Down's syndrome is a risk factor in patients with functionally single ventricle due to persistent pulmonary hypertension and airway obstruction. These results show that single ventricle repair in patients with Down's syndrome is accompanied with difficulties, and patient selection for the Fontan procedure should be done carefully.
No preview · Article · Apr 2008 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: Tricuspid regurgitation (TR) is known to be a risk factor for mortality in the surgical management of patients with hypoplastic left heart syndrome (HLHS). Concomitant repair for TR should be considered when the TR is moderate to severe to achieve successful Fontan completion. The present case was a 20-month-old girl who was diagnosed with HLHS (mitral atresia and aortic atresia). She underwent a Norwood procedure as the first palliation followed by a Glenn procedure. After that, she gradually developed TR, which progressed to a severe state at the time of the Fontan procedure. An edge-to-edge tricuspid valve repair, in which the anterior and septal leaflets were sutured together, was performed simultaneously with the extracardiac Fontan procedure. Discharge echocardiography revealed that the degree of TR was less than mild. The technique is simple, not time-consuming, and may be an effective adjunct for successful completion of the Fontan procedure in these patients.
No preview · Article · Jan 2008 · General Thoracic and Cardiovascular Surgery
[Show abstract][Hide abstract] ABSTRACT: There is a limitation to the ability of the tricuspid or common atrioventricular valve to function in the systemic position, and insufficiency of these valves often carries an important risk during the staged surgical reconstruction in single ventricle. The purpose of this study was to assess the efficacy of edge-to-edge repair, involving suturing of the free-floating segments of the opposing leaflets, applied in this context.
Between 1989 and 2006, 49 patients with tricuspid or common atrioventricular valve regurgitation (moderate or greater) associated with single ventricle underwent valve repair 53 times. Edge-to-edge repair was performed in 5 of 23 with tricuspid valve and 17 of 30 with common atrioventricular valve.
In the edge-to-edge group, more patients had severe regurgitation (59.1%) compared with the non-edge-to-edge group (32.3%) before operation (p = 0.0906). The postoperative degree of regurgitation was mild or less in 95.5% of the edge-to-edge group compared with 48.4% of the non-edge-to-edge group (p = 0.0003). Tricuspid or atrioventricular valve stenosis was not observed in any of the patients after repair. The degree of regurgitation on follow-up echocardiogram was mild or less in 77.3% of the edge-to-edge group at 2.6 +/- 4.0 years after repair, compared with 38.7% of the non-edge-to-edge group at 1.9 +/- 3.2 years (p = 0.109).
Edge-to-edge repair was an effective adjunctive in repairing tricuspid or common atrioventricular valve associated with functionally single ventricle. An excellent reduction of regurgitation was observed in most of the patients, and may lead to preservation of ventricular function during interim stage and successful completion of the Fontan operation.
No preview · Article · Dec 2007 · The Annals of thoracic surgery
[Show abstract][Hide abstract] ABSTRACT: A 10-year-old boy had undergone conventional two-stage surgery that included repair of aortic coarctation with pulmonary artery banding as an initial operation followed by closure of a ventricular septal defect as a secondary procedure. Following these procedures, aortic coarctation recurred, and balloon angioplasty was performed three times. Aortic recoarctation, however, persisted, and aortic stenosis and regurgitation and pulmonary stenosis gradually developed. An operation was therefore performed to repair recoarctation, aortic stenosis and regurgitation, and pulmonary stenosis. Patch aortoplasty was performed for recoarctation. The aortic valve was replaced with a 19 mm On-X valve, with Konno root enlargement. Pulmonary arterial patch plasty was also performed. During aortic arch reconstruction, selective cerebral perfusion was performed via the innominate artery and left carotid artery, and the lower half of the body was perfused through a cannula in the left femoral artery. The postoperative course was uneventful, and aortography revealed a well-reconstructed aortic arch free of obstruction. There were no valve-related complications.
Full-text · Article · May 2007 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: The ideal timing and optimal management of surgical repair for isolated complete atrioventricular septal defect (CAVSD) still remains controversial. To determine outcomes after the surgical repair of CAVSD, we reviewed 100 consecutive patients who underwent complete repair at our institute between January 1992 and August 2003. Among these 100 patients, 52 were female and 73 had Down's syndrome. Twelve had received preceding pulmonary artery banding. A two-patch repair was employed in all cases. The patients' median age and weight were 4.5 (1.2-48) months and 4.7 (2.5-12.5) kg, respectively. The mean stays in the intensive care unit and in the hospital were 5.3+/-3.8 and 25.4+/-18.1 days, respectively. The median duration of mechanical ventilation was 11.6 h. There were two in-hospital deaths, in patients 5.2 and 5.9 months of age. Both had underlying Down's syndrome, and significant pulmonary vascular obstructive disease (PVOD) was detected on postmortem specimen. The operative outcome of CAVSD was generally satisfactory. PVOD can progress rapidly from four to five months, especially with Down's syndrome. Therefore, in order to avoid progression to irreversible PVOD, surgical intervention within four months of birth may be appropriate in such patients.
Preview · Article · Mar 2007 · Interactive Cardiovascular and Thoracic Surgery