URGENT CARDIAC OPERATIONS IN NEONATES AND INFANTS WITHOUT CATHETERIZATION

Problem: Preoperative cardiac catheterization may be hazardous for cri tically ill neonates and infants. We evaluated in which cases urgent c ardiac operations could be performed based on echocardiographic findin gs alone. Methods: Between 1990-1993, 24 patients aged 1 day to 4 mont hs underwent surgery without cardiac catheterization. Preoperative ech ocardiographic diagnosis were compared with intraoperative findings an d postoperative results of catherizations. In patients with valvular a ortic stenosis or coarctation Doppler pressure gradients and left vent ricular function were studied pre- and postoperatively. Results: In al l but one case preoperative echocardiographic diagnoses were correct a nd confirmed by the intraoperative anatomy and subsequent catheterizat ion studies. In particular patients with valvular aortic stenosis or c oarctation can be operated on with good results without previous cathe terization; postoperative echocardiography showed a significant reduct ion of Doppler pressure gradients and a restoration of left ventricula r function. In cyanotic lesions echocardiography seems to be reliable for planning a palliative shunt procedure. We lost one patient in whom interrupted aortic arch type C was misdiagnosed as coarctation and co nclude that preoperative cardiac catheterization is still necessesary in complex aortic arch anatomy, in coronary artery anomalies and whene ver perfect imaging cannot be achieved.