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[Heart surgery in newborn infants and in early infancy]
Insights
Surgical intervention improved outcomes for 78% of newborns with treatable heart conditions. For complex cardiac lesions, surgery offered a chance for survival despite high risks, aiding in salvaging infants.
Area of Science:
- Pediatric Cardiology
- Neonatal Surgery
- Congenital Heart Disease
Context:
- 127 neonates with severe anoxia, cardiac failure, or respiratory issues due to cardiac lesions underwent surgery.
- Surgical treatment for some congenital heart defects (e.g., coarctation of the aorta) is well-established.
- High mortality rates with medical management for complex lesions (e.g., interrupted aortic arch) prompted surgical intervention.
Purpose:
- To evaluate the outcomes of surgical interventions in neonates with severe cardiac conditions.
- To assess the feasibility and effectiveness of surgical treatment for complex congenital heart defects in newborns.
- To explore the role of clinical assessment and diagnostic tools like cine-angiocardiography in surgical decision-making.
Summary:
- Neonates with congenital heart disease underwent surgical correction, with 78% experiencing cure or improvement for established procedures.
- For complex lesions, surgery was pursued to salvage infants facing fatal outcomes with medical treatment.
- Key elements for success included light anesthesia, experienced postoperative care teams, specific fluid management, and respiratory physiotherapy.
Impact:
- Surgical intervention significantly improved survival and quality of life for neonates with various congenital heart defects.
- This study highlights the critical role of timely surgical management in improving outcomes for critically ill infants with cardiac lesions.
- The findings support the aggressive surgical approach for complex congenital heart diseases in neonates, even with high inherent risks.
Abstract:
During the past five years, 127 newborn infants with marked anoxia, severe cardiac failure or respiratory problems secondary to a cardiac lesion were operated upon at l'Hôpital Ste-Justine, Montreal, Quebec.Infants in cardiorespiratory distress from a cardiac lesion for which the surgical treatment is well established, such as complicated coarctation of the aorta, were either cured or improved in 78% of cases. The fatal outcome following medical treatment of patients suffering from lesions for which the surgical treatment is not yet well established, e.g. interruption of the aortic arch, led us to operate upon these infants with the hope of salvaging some of them despite the high surgical risk.The decision to operate was usually based on clinical grounds; however, cine-angiocardiography was at times required to establish the exact diagnosis. Light anesthesia was essential to the success of the operation. Postoperative care was facilitated by a team of nurses well experienced in the treatment of newborn subjects with heart lesions. Fluids were administered in a minimum quantity of 700 c.c./m.(2) for 24 hours, and potassium was the only electrolyte added to the replacement fluids. Respiratory problems were reduced to a minimum by active physiotherapy. However, intubation with aspiration of tracheobronchial secretions was carried out when necessary.