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Gastroesophageal reflux in association with congenital heart disease
Insights
Severe respiratory symptoms in infants with congenital heart disease and gastroesophageal reflux are often overlooked. Combined cardiac repair and antireflux procedures effectively relieved symptoms in most infants, unlike medical therapy alone.
Area of Science:
- Pediatric Cardiology
- Gastroenterology
- Neonatology
Background:
- Infants with congenital heart disease (CHD) and gastroesophageal reflux (GER) often present with severe respiratory symptoms.
- Comorbidities like Down Syndrome or central nervous system (CNS) disease are common in these infants.
- The contribution of GER to respiratory issues in CHD patients is frequently underestimated.
Purpose of the Study:
- To describe the clinical course of infants with concurrent CHD and GER.
- To evaluate the effectiveness of different management strategies for respiratory symptoms in this population.
Main Methods:
- Retrospective review of 19 infants with severe respiratory symptoms, CHD, and GER.
- Analysis of clinical outcomes based on medical therapy, cardiac intervention, and antireflux procedures.
Main Results:
- Only one of 19 infants improved with medical therapy alone.
- Thirteen of 19 infants experienced symptom relief following cardiac repair/palliation, with or without antireflux surgery.
- GER was often a significant, yet overlooked, factor in respiratory complications.
Conclusions:
- GER is a critical factor in respiratory distress for infants with CHD.
- Early surgical intervention for cardiac defects, potentially combined with antireflux procedures, offers the best outcome.
- A high index of suspicion for GER is crucial in managing respiratory symptoms in infants with CHD.
Abstract:
The clinical course of 19 infants with severe respiratory symptoms associated with the presence of both congenital heart disease and gastroesophageal reflux is described. Down Syndrome or central nervous system disease was present in 12 of the 19 infants. The identification of reflux as a major or additional cause of the respiratory complications was often overlooked. Medical therapy alone was successful in only one of the 19 patients. Early repair or palliation of the cardiac malformation with or without subsequent antireflux surgical procedure was associated with relief of the symptoms in 13 patients.