PubMed · 9820726
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1998. Bibliography.. https://doi.org/10.1089/lap.1998.8.325
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Upper airway obstruction is a prevalent feature in patients with Down syndrome. However, these patients may be completely asymptomatic in the early months of life. The recognition of a problem within the airway quite often occurs when these children present for cardiac surgery, diagnostic radiography with sedation, or during the induction and intubation for anesthesia. Tracheal stenosis is rare in the general population, but is seen somewhat more frequently in patients with Down syndrome. The incidence of tracheal stenosis in children with congenital heart disease, which is seen in 40% of patients with Down syndrome, has been reported to be 1.2%. Patients with Down syndrome also tend to have other upper airway obstructive pathology such as nasopharyngeal, oropharyngeal, and subglottic compromise. These entities, combined with the high incidence of cardiac disease, put these children at risk for acute and chronic cardiopulmonary compromise. We present two patients with Down syndrome and congenital heart disease who were found to have significant tracheal stenosis at the time of their cardiac surgery. The perioperative management of their airway defects including diagnostic evaluation and treatment modalities are discussed.
Patients with severe heart failure due to valvular disease or coronary artery disease often benefit from conventional heart surgery even in the presence of severe left ventricular dysfunction. If a conventional procedure is not possible, left ventricular reconstructive surgery can be of value in selected cases. In cases of idiopathic dilated cardiomyopathy, the Batista procedure can improve left ventricular function, whereas in patients with ischemic cardiomyopathy, with or without left ventricular aneurysm, an endoventricular patch plasty with septal exclusion might be of value. Some patients with dilated cardiomyopathy and severe mitral regurgitation can benefit from a simplified mitral valvuloplasty.
Local intra-arterial lysis using recombinant tissue plasminogen activator (rTPA) was performed in a 6 and 2/3-year-old patient with major cardioembolic ischemic stroke 48 hours after intracardiac surgery. Selective application of 2.5 mg rTPA (0.11 mg/kg body weight) resulted in recanalization of the occluded cerebral vasculature with good neurologic recovery.