Downs syndrome and cardiac surgery, a dilemma, should we operate or not?

BackgroundIncidence of congenital heart disease in patients with Down syndrome (DS) is 40%. In the past some have advocated that the cardiac defects in DS should not be repaired, reports had shown outcome comparable to individuals without DS. The aim of the study is to analyze the outcome of cardiac surgery in DS.MethodologyWe conducted a retrospective study in the last 2 years at our institution. Patients involved were DS less than 13 years who had cardiac surgery. DS with chronic lung disease or unreactive pulmonary hypertension were excluded. We analyzed their demographic data, cardiac lesion, type of surgery, ICU stay, morbidities and mortality.Results23 patients with DS (11 Females, 13 Males), with median age of 7 months, mean age of 32month. AVSD were (n=15) 65%), VSD were (n=5) 21%. Postoperatively, 21% were extubated on the same day. 27% had intubation more than 9 days. Almost 30% had a hospital stay of >15 days. Complications were respiratory problems in 45%, arrhythmias in 8% and residual AV valve regurgitation in 8%. Hospital mortality was (n=2/23) 8%.ConclusionWhether to operate Down syndrome patients or not remains unclear. Our study showed, significant postoperative complications, lengthy hospital stay and relatively high mortality. Despite of this we feel they should be given the chance of surgery to improve their life quality

62. Recombinant tissue plasminogen activator in neonates: Potential risks and benefits

Life-threatening intra-cardiovascular thrombi are rare in neonates. Recombinant tissue plasminogen activator (rTPA) which stimulates fibrinolysis, is used in adults to facilitate thrombus resolution. Its use along with heparin in neonates remains controversial because of potential risk of serious bleeding. Our aim was to present our experience with the use of thrombolytic agents in seven neonates and young infants. All neonates and one 45 days old infant, between Jan. 2008 and Jan. 2014, with intracardiac and/or intravascular thrombii who were treated either by thrombolytic agents or by heparin alone were included. The following factors were collected: demographic data, primary diagnosis, and site of thrombus, risk factors, method of diagnosis, route and duration of treatment, dosage of thrombolytic and/or anticoagulation agent, complications and outcome. Results: Seven patients were identified. Age range was from five days to 45 days (median age 12 days), median weight 2.9 kg (range 0.9–3.8 kg). The thrombi were diagnosed by echocardiography in five cases and in two by angiography. All patients had life threatening thrombi; four were treated with rTPA and heparin infusions with complete dissolving of the thrombi within short time (2–96 h) without complications. The other three patients (two were premature, 28 and 34 weeks of gestation, and the other had deranged coagulation profile) were treated with unfractionated heparin due to fear of bleeding. The thrombus was dissolved in the premature babies and embolized in the other one, which led to his death. Conclusion: Our small case series, confirmed the effectiveness and safety of the used dosage of intravenous infusion of recombinant tissue plasminogen activator in neonates with life threatening thrombi