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Ann Thorac Surg 1996;61:1589-1590
© 1996 The Society of Thoracic Surgeons

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Correspondence

Two-Patch Repair of Atrioventricular Canal

Magdalena Tdziagolska, MD

Department of Anaesthesia, Clinic of Paediatric Surgery Cardiosurgery, Medical Academy, Dziadowska 1 Str, 01-184 Warszawa, Poland

To the Editor:

I have found the article by Dr Backer and associates [1] very interesting, but I cannot agree with one of the thoughts expressed in the Comment section and typical, in my opinion, of many surgeons.

Doctor Backer and associates write, ``Preoperative need of assisted ventilation because of respiratory distress, congestive heart failure, or pneumonia can result in major morbidity,'' and later, ``...the only two early deaths were in patients who had preoperative assisted ventilation for congestive heart failure complicated by viral bronchiolitis.'' As I understand it, the major morbidity or early deaths were results of respiratory distress, congestive heart failure, pneumonia, and viral bronchiolitis in children with congenital heart disease. Assisted ventilation was one of the procedures that saved the life of these patients and allowed the surgeon to perform repair of complete atrioventricular canal defect with the two-patch technique.

Reference

1. Backer CL, Mavroudis C, Alboliras ET, Zales VR. Repair of complete atrioventricular canal defects: results with two-patch technique. Ann Thorac Surg 1995;60:530–7.[Abstract/Free Full Text]

Reply

Division of Cardiovascular-Thoracic Surgery, Children's Memorial Hospital, 2300 Children's Plaza, Box 22, Chicago, IL 60614

To the Editor:

The letter from Dr Tdziagolska highlights an interesting problem with regard to the management of patients with atrioventricular canal defects. Doctor Tdziagolska points out that the use of assisted ventilation may be life-saving for a child with an atrioventricular canal defect in whom preoperative congestive heart failure or pneumonia with respiratory failure develops. My colleagues and I could not agree more with this. Clearly, if these children require preoperative assisted ventilation, we have no hesitation in pursuing this course as essentially there are no other options. Thus there is no question that assisted ventilation is a procedure that can save the life of these patients and allow a period of stabilization before the repair is performed.

However, from a surgeon's standpoint, it should be recognized that a child who requires assisted ventilation because of congestive heart failure or pneumonia and who also has a complete atrioventricular canal defect is at increased risk for complications after intracardiac repair compared with a child who is admitted electively for repair. This was substantiated in our experience and in other series. This is the point we were trying to make. We were certainly not discouraging the use of preoperative assisted ventilation for these infants if that is necessary.

I appreciate Dr Tdziagolska focusing attention to this point and hope that this has clarified the issue. We continue to recognize the importance of anesthesiologists in caring for these patients!

This Article Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Tedziagolska, M. Articles by Backer, C. L. Search for Related Content PubMed Articles by Tedziagolska, M. Articles by Backer, C. L.