Open-heart surgery in the first week of life.
The high mortality of open-heart operations in infants with congenital heart disease has traditionally led to deferral of definitive operation and to use of medical therapy or palliative procedures. The technique of deep hypothermia with circulatory arrest and advances in intensive care have made early repair possible. Since 1973, we have repaired life-threatening but correctable lesions in 11 infants in the first week of life. There are 7 survivors. Four patients had total anomalous pulmonary venous drainage, 2 had truncus arteriosus (1 with aortic arch interruption), and 1 each had pulmonary atresia and intact ventricular septum, critical pulmonary stenosis and intact ventricular septum, D-transposition of the great vessels, tetralogy of Fallot, and left ventricular-aortic tunnel. Postoperative hypoglycemia (less than 50 mg per 100 ml) developed in 4 patients and hypocalcemia (less than 7 mg per 100 ml), in 5. These problems responded appropriately to replacement therapy. Three of the survivors experienced renal failure, a complication subsequently prevented by use of mild hemodilution perfusion. Two patients had major bleeding, which now is prevented by finer suturing and administration of vitamin K and platelets. One infant, moribund with pH of 6.8 when brought to operation, sustained a cardiac arrest with subsequent brain damage. We conclude that newborns with life-threatening malformations can undergo successful repair. Attention must be paid to their unique metabolic demands, and surgical technique must be meticulous. Early operation before clinical deterioration is essential.
D005500:Follow-Up Studies; D006323:Heart Arrest / Q000209:etiology; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D006996:Hypocalcemia / Q000209:etiology; D007003:Hypoglycemia / Q000209:etiology; D007036:Hypothermia, Induced; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000209:etiology; D011183:Postoperative Complications