Aortopulmonary Septal Defect Follow-up
- Author: Barry A Love, MD; Chief Editor: Stuart Berger, MD more...
Further Outpatient Care
Provide follow-up care within 1-2 weeks following discharge.
Patients are commonly discharged on diuretics, but if a good repair is achieved, most patients can be weaned from cardiac medications soon after discharge.
Even in the absence of clinically evident problems, at least one postoperative echocardiogram should be performed during follow-up to evaluate for potentially silent problems.
Further Inpatient Care
If required, preoperative inpatient care of patients with aortopulmonary septal defect (APSD) is directed at managing congestive heart failure (CHF) and completing the diagnostic evaluation in anticipation of surgery.
Postoperative care should focus on managing pulmonary hypertension, evaluating for residual defects, and aiding convalescence in anticipation of discharge.
Inpatient & Outpatient Medications
Endocarditis prophylaxis is no longer recommended for most patients with congenital hart disease with the exception of the following :
- Those who have had prior endocarditis
- Those with prosthetic heart valves
- Those with unrepaired cyanotic congenital heart disease (eg, palliative shunts and conduits)
- Those with completely repaired congenital heart defects that were repaired with prosthetic materials/devices within 6 months of the procedure
- Those with turbulence near patch material
Therefore, most patients with repaired and unrepaired aortopulmonary septal defect do not require endocarditis prophylaxis. Refer to the American Heart Association and American College of Cardiology guidelines.[32, 33, 31]
The most concerning complication in the repair of aortopulmonary septal defect is perioperative death from pulmonary hypertensive crisis in the child with pulmonary vascular obstructive disease (PVOD).
Other generic surgical complications include, but are not limited to, infection, brain injury, and permanent heart block. Although these are considerations, they should be of no higher risk in this procedure than they are in other cardiac procedures using cardiopulmonary bypass.
Specific anatomic risks of repair include incomplete closure of the defect and aortic or pulmonary artery distortion. Other complications may relate to repair of associated defects.
Infants with an isolated aortopulmonary septal defect have an excellent prognosis for normal cardiac function and a normal lifestyle.
Patients with a more guarded prognosis include older patients with pulmonary resistance of greater than 8 Wood U/m2 at preoperative assessment and those with more complex associated malformations where prognosis depends more on those lesions than on aortopulmonary septal defect.
A small incidence of reintervention for stenosis of the great arteries has been reported.
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