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Surgical management of congenital cardiac defects in neonates and young infants born with extremely low weight

Published online by Cambridge University Press:  24 May 2005

Hiroaki Kawata ,
Hidefumi Kishimoto ,
Takuya Miura ,
Tohru Nakajima  and
Hiroyuki Kitajima
Hiroaki Kawata
Affiliation:
Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi City, Osaka, Japan
Hidefumi Kishimoto
Affiliation:
Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi City, Osaka, Japan
Takuya Miura
Affiliation:
Department of Cardiovascular Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi City, Osaka, Japan
Tohru Nakajima
Affiliation:
Department of Pediatric Cardiology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi City, Osaka, Japan
Hiroyuki Kitajima
Affiliation:
Department of Neonatology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi City, Osaka, Japan
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Abstract

Surgical treatment of cardiac defects in infants born with extremely low weight is sometimes required during the neonatal period. Optimal timing of these operations has yet to be clarified. With this in mind, we reviewed our experience of surgical treatment for 29 infants born with extremely low weight between 1994 and 2001. The main surgical procedures were ligation of a patent arterial duct in 26, a Brock procedure in 2, and ligation of an aorto-pulmonary window in 1 infant. The age at operation ranged from 5 to 57 days, with a median of 30 days, and weighed from 506 to 902 g, with a median of 710 g. There were no deaths. For the 2 infants undergoing the Brock procedure, the reduced systemic blood flow also necessitated closure of the arterial duct. For almost all the 26 infants with a patent arterial duct, indomethacin was given as the initial therapy, but the duct had not closed completely. Increased symptomatology just before the operation due to reduced systemic blood flow, such as decreased cerebral blood flow, decreased urine output, and intestinal ischemia, mandated the earlier surgical ligation (r = −0.576, p = 0.004). The youngest infant needed an infusion of catecholamines perioperatively to maintain stable hemodynamic conditions (r = 0.554, p = 0.003). In 4 infants, including the youngest 2, steroids were administered intravenously just after the ligation. Our results suggest that reduced systemic blood flow is the main indication of surgical repair in infants born with extremely low weight. Even for one in whom the supply of pulmonary blood is dependent on the arterial duct, early reconstruction of the pulmonary arterial pathways, using the Brock procedure, followed by ligation of the duct, is required. Acute adrenal insufficiency should not be overlooked just after the surgery, particularly in the youngest patients.

Keywords

Prematuritypatent arterial ductadrenal insufficiency
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 4 , August 2003 , pp. 328 - 332
Copyright
© 2003 Cambridge University Press

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References

Chang AC, Hanley FL, Lock JE, Castaneda AR, Weissel DL. Management and outcome of low birth weight neonates with congenital heart disease. J Pediatr 1994; 124: 461–466.Google Scholar
Reddy VM, McElhinney DB, Sagrado T, Parry AJ, Teitel DF, Hanley FL. Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams. J Thorac Cardiovasc Surg 1999; 117: 324–331.Google Scholar
Grosfeld JL, Chaet M, Molinari F, et al. Increased risk of necrotizing enterocolitis in premature infants with patent ductus arteriosus treated with indomethacin. Ann Surg 1996; 224: 350–355.Google Scholar
Eronen M, Kari A, Pesonen E, Hallman M. The effect of antenatal dexamethasone administration on the fetal and neonatal ductus arteriosus. Arch Pediatr Adolesc Med [Am J Dis Child] 1993; 147: 187–192.Google Scholar
Jobe AH, Mitchell BR, Gunkel JH. Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants. Am J Obstet Gynecol 1993; 168: 508–513.Google Scholar
Kawata H, Kishimoto H, Ueno T, Nakajima T, Inamura N, Nakada T. Repair of aortopulmonary window in an infant with extremely low birth weight. Ann Thorac Surg 1996; 62: 1843–1845.Google Scholar
Perez CA, Bustorff-Silva JM, Villasenor E, Fonkalsrud EW, Atkinson JB. Surgical ligation of patent ductus arteriosus in very low birth weight infants: Is it safe? Am Surg 1998; 64: 1007–1009.Google Scholar
Robie DK, Waltrip T, Garcia-Prats JA, Pokorny WJ, Jaksic T. Is surgical ligation of a patent ductus arteriosus the preferred initial approach for the neonate with exremely low birth weight? J Pediatr Surg 1996; 31: 1134–1137.Google Scholar
Padbury JF, Ervin MG, Polk DH. Extrapulmonary effects of antenatally administered steroids. J Pediatr 1996; 128: 167–172.Google Scholar
Trus T, Winthrop AL, Pipe S, Shah J, Langer JC, Lau GYP. Optional management of patent ductus arteriosus in the neonate weighing less than 800 g. J Pediatr Surg 1993; 28: 1137–1139.Google Scholar
Cassady G, Crouse DT, Kirklin JW, et al. A randomized, controlled trial of very early prophylactic ligation of the ductus arteriosus in babies who weighed 1000 g or less at birth. N Engl J Med 1989; 320: 1511–1516.Google Scholar
Farstad T, Bratlid D. Pulmonary effects of closure of patent ductus arteriosus in premature infants with severe respiratory distress syndrome. Eur J Pediatr 1994; 153: 903–905.Google Scholar
Shortland DB, Gibson NA, Levene MI, Archer LN, Evans DH, Shaw DE. Patent ductus arteriosus and cerebral circulation in preterm infants. Dev Med Child Neurol 1990; 32: 386–393.Google Scholar
Scott SM, Watterberg KL. Effect of gestational age, postnatal age, and illness on plasma cortisol concentrations in premature infants. Pediatr Res 1995; 37: 112–116.Google Scholar
Watterberg KL, Scott SM, Backstrom C, Gifford KL, Cook KL. Links between early adrenal function and respiratory outcome in preterm infants: airway inflammation and patent ductus arteriosus. Pediatrics 2000; 105: 320–324.Google Scholar
Clyman RI, Mauray F, Roman C, et al. Effects of antenatal glucocorticoid administration on ductus arteriosus of preterm lambs. Am J Physiol 1981; 100: H415–H420.Google Scholar