ASO for D-TGA in the first hours of life is a good option for the treatment of critically ill neonates with metabolic disorders. In our experience, there is no need for the Rashkind procedure to stabilize the patient before surgery.
Aim. Early detection and timely appropriate surgical treatment of congenital heart disease in order to reduce infant mortality.
Methods. The algorithm was designed for the prediction of critical conditions in congenital heart disease in newborns. The algorithm is simple to use, because it does not set a pediatrician-neonatologist a difficult task for the accurate diagnosis of congenital heart disease, but leads physician from the syndromic diagnosis to a certain group of diseases and, therefore, appropriate strategy of patient treatment and management. The algorithm combines both syndromes and hemodynamic conditions causing them. The conditions are divided into fetal-dependent and fetal-independent, which determines the time of surgery. The questionnaire consisting of a series of questions with multiple choice answers helps the doctor to see into the symptoms and syndromes. The questions are made in a way to emphasize the certain signs, the details of medical history and disease progression to pediatricians. It is important to notice that 13 out of 20 questions are based on the medical history and clinical picture, 7 questions are based on the test results such as electrocardiography, radiography, and do not include echocardiography.
Results. Since 2000, the questionnaire was implemented in the Republic of Tatarstan as a recommended diagnostic algorithm for examining newborns with congenital heart disease. Since 2003, the questionnaire and algorithm for prediction of the critical conditions was introduced by the order №867 of the Ministry of Health of the Republic of Tatarstan «On measures to improve health care in congenital heart disease in children». Remote consultations with maternity hospitals are strictly based on them. They carry a certain training load, and when doctors pronounce aloud all the items of the test, the examination algorithm gradually becomes automatic.
Conclusion. During 13 years of using the proposed diagnostic algorithm for congenital heart disease with physiological rationale for palliative care and timely terms of surgery, the mortality rate from congenital heart disease in the Republic of Tatarstan has significantly dropped.
We report a case of a 4-month-old infant with dextro (d)-transposition of the great arteries, ventricular septal defect (VSD) and left ventricular outflow tract obstruction previously palliated with a systemic-to-pulmonary shunt. He underwent repair by aortic root translocation with an arterial switch procedure and coronary artery reimplantation (modified Bex-Nikaidoh operation). This case demonstrates that aortic translocation results in a more normal anatomic repair compared with the Rastelli operation. As shown, it is always possible to place an oversized conduit (homograft) and there is no risk of sternal compression of the conduit. This is especially important for children under 1 year, when there are contraindications for the Rastelli operation. Placement of oversized pulmonary ventricle-pulmonary artery conduits is performed to decrease conduit failure in the future. The postoperative course was uneventful. At 6 months, he was asymptomatic with tomographic images and echocardiography showing no residual lesions.
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