S. Kotthoff et al., URGENT CARDIAC OPERATIONS IN NEONATES AND INFANTS WITHOUT CATHETERIZATION, Monatsschrift fur Kinderheilkunde, 143(6), 1995, pp. 594-598
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.