The evolution of surgical treatment for congenital cardiac disease
Article Abstract:
Infants born with defects of the heart and associated blood vessels used to die soon after birth. However, since the 1950s and 1960s, when surgical techniques to repair these cardiac anomalies were introduced, the life span of affected children has increased measurably. Initially, survival in the period after surgery was the focus of study, but many patients have now lived for many years following reparative surgery, allowing analysis of long-term survival and causes of death. A report by Morris and Menashe, to be published in JAMA, the Journal of the American Medical Association, studied all children from the state of Oregon who underwent reparative surgery for congenital heart defects before the age of 18 years. Most were treated at one institution, under the leadership of one surgeon. During the last 30 years, the age at surgery has decreased and in-hospital mortality has fallen substantially. Lingering cardiac illness and mortality were observed in some patients, particularly those with aortic stenosis (constriction), coarctation (stricture or narrowing) of the aorta, and transposition of the great arteries. Heart arrhythmias, congestive heart failure, and obstructive disease of the pulmonary (lung) blood vessels with pulmonary hypertension were the main causes of late mortality. Several features could have been improved in the study, including assessment of the outcomes of nonoperated patients and a better statistical analysis. Improved understanding of fetal and neonatal physiology has been crucial to improved survival; advancements in neonatology have allowed the development of medications that are beneficial for newborns, improved anesthetic, surgical, and postoperative treatments, and have made it possible to treat very young infants. With increasing surgical experience, the occurrence of restenosis and persistent hypertension in children with coarctation of the aorta may be minimized; addressing progressive coronary artery disease in these patients is important. Long-term patient function and survival will be maximized with a combination of early detection and surgery, appropriate postsurgical treatment, and fastidious long-term follow-up care. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Diseases of Children
Subject: Health
ISSN: 0002-922X
Year: 1991
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Surfactant therapy failure identifies infants at risk for pulmonary mortality
Article Abstract:
Premature infants with respiratory distress syndrome (RDS) who do not respond to surfactant replacement therapy within six hours are at high risk for death from respiratory distress syndrome (RDS). Of 99 infants with RDS whose records were reviewed and who received surfactant therapy, 49 showed improvement within six hours of treatment. Improvement or lack of improvement following treatment was based on the percentage of oxygen measured by an oxygen index. Of the 50 remaining infants, 32 showed no improvement following treatment, and 11 died before they were 10 days old. The infants who died tended to have more immature respiratory systems and to weigh less than those who survived. In general, those who did not respond to therapy but survived were larger than their counterparts who responded to treatment, even though their gestational ages were the same. Identification of the differences between surfactant-responsive and surfactant-unresponsive infants should lead to the development of alternative therapies for RDS.
Publication Name: American Journal of Diseases of Children
Subject: Health
ISSN: 0002-922X
Year: 1993
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