Cardiac Surgery in the Newborn and Infant(招待講演I, 第20回日本小児外科学会総会)

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概要

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• Cardiac surgery in the very young continues to be a challenge. Operative mortality is consistently higher than in the older child. Improved diagnostic, anesthetic and operative techniques as well as postoperative care have progressively lowered the age of highest risk (1-8). Consequently, more infants are referred earlier for palliation or corrective surgery. However, there remains an age limit below which operative risk is increased. To illustrate the problem of age related risk I reviewed all infants less than age 31 days who underwent cardiac surgery during past 3 years at Hospital for Sick Children, Toronto. The first month of life was selected arbitrarilly, the exact age of higher risk being rather vague. Three hundred and fifty four infants under 1 month of age underwent a total of 366 cardiac operations during this 3 year period of 1980, 81 and 82, inclusive. Operative mortality is 23.8% in this group, significantly higher than the 3.7% mortality for the 1,568 patients over the age of 1 month (P=.0001). While the infants under 1 month constitute only 19% of all cardiovascular operations in our institution, they contribute 61% of the total mortalily. Clearly, if we are to improve future results in congenital heart surgery the newborn group must be the focus of our efforts. Why is surgery in the newborn period risky? Does age alone contriburte to increased mortality? Is the severity of the cardiac defect significantly worse? Is there a metabolic immaturity in the infant which precludes a successful outcome for surgical interventation? Are there more associated non-cardiac diseases contributing to the newborn's illness or are there other still un-recognized factors affecting the newborn? All of these factors may be involved in any one newborn and progress will depend on controlling their various negative influences. The range of diagnosis in this group of newborns in very large (Table 1). The only common factor is that all of these infants were acutely ill requiring urgent or emergency surgical treat-ment. Many lessons can be learned from examining each of these groups in detail. Time and space does not permit elaboration about each group and I will limit my comments to the more frequently encountered lesions. The first 4 diagnoses (Table 1) encompass 76% of the infants. Notice too that the commonly encountered atrial and ventricular septal defects (VSD) seen in older infants and children in-frequently cause surgical intervention in the newborn.

• 特定非営利活動法人日本小児外科学会の論文
• 1983-08-20

著者

• Williams William

  Hospital For Sick Children Toront Ontario Canada

• Williams William

  Hospital For Sick Children

関連論文

• Cardiac Surgery in the Newborn and Infant(招待講演) (第20回日本小児外科学会総会)
• Cardiac Surgery in the Newborn and Infant(招待講演I, 第20回日本小児外科学会総会)

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