Asim Khan, Tariq Waqar, Muhammad Zubair Ahmad Ansari.
Operative Results of Surgical Repair of Complete Atrioventricular Septal Defect (CAVSD) in High Risk Infants and Children.
Ann Pak Inst Med Sci Jan ;11(1):26-9.

Objective: To present operative results of Complete atrioventricular septal defects repair in high risk infants and children. Methods: Retrospective case series of high risk infant and children operated at Children Hospital and Institute of Child Health Lahore, Pakistan during January 2007 to December 2013. Patients were considered as high risk if any of three or more of following patient characteristics were present i.e. age more than 6 months, Down’s syndrome, growth retardation (less than 50 percentile of expected age), and recent cardiac failure requiring hospitallization, Severe pulmonary hypertension. Baseline characteristic of patients, their operative finding and results were retrieved from hospital record. Results: Corrective surgery were performed on 56 patients high risk CAVSD during 2007 to 2013. Patients’ age ranged from 3 month to 30 months (mean age i.e. 15.11 + 25.96 month). Among the preoperative risk factor, 32.1% patients had Down syndrome, 66.07% growth retardation, 60.71%% recently treated cardiac failure and 57.14% severe pulmonary hypertension. These patients were admitted one week before surgery to optimize the medical therapy for congestive cardiac failure and pulmonary hypertension along with efforts to improve nutritional status as departmental policy. All patients had Rastelli type A complete atrioventricular canal defect. 51 patients were operated with two patch technique and 5 patients with single patch technique. Following were operative variable i.e. Mean cardiopulmonary bypass time 85.46 + 18.62 min and Aortic cross clamp time 60.87 + 13.33 min. Operative results were as following i.e. postoperative ventilation time 44.64 + 21.67 hours, permanent third degree atrioventricular (AV) block 1.8%, length of hospital 7.8 + 1.8 days, mitral regurgitation of grade 3+ or more 1.8% and operative mortality 7.1%. Conclusion: Repair of CAVSD in high risk pediatric population is feasible with preoperative optimization of treatable risk factor to improve operative outcome.

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