Endocardial Cushion Defects Follow-up

Updated: Sep 15, 2014
  • Author: Mary C Mancini, MD, PhD, MMM; Chief Editor: Park W Willis IV, MD  more...
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Follow-up

Further Outpatient Care

Continued observation is needed with regularly scheduled echocardiography in order to assess the integrity of the AV valvular reconstruction. This area is prone to development of valvular insufficiency that may require further intervention as the child grows older.

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Further Inpatient Care

Postoperative recovery requires 5-10 days of hospitalization, depending upon the condition of the child prior to surgery and whether palliative or complete correction is undertaken. With palliation (ie, pulmonary artery banding), the presurgical condition of volume overload still must be regulated. With complete correction, recovery generally is uneventful.

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Inpatient & Outpatient Medications

Digitalis: This agent provides myocardial support during the postoperative period and can be discontinued after 2-3 years.

Diuretics: Generally, furosemide is prescribed for several months after repair in order to correct volume overload; it is discontinued once euvolemia is reached.

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Deterrence/Prevention

The current limited knowledge of the genetic abnormalities that predispose to the formation of the endocardial cushion defect can be expanded greatly with current advances in the Human Genome Project. As the knowledge base expands, prenatal detection and possibly treatment may be possible in the future.

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Complications

Since synthetic material is used to repair the atrial and ventricular septal defect, the child is at risk of infection. Other potential complications include complete heart block, ventricular arrhythmia, and AV valve stenosis and/or insufficiency.

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Prognosis

The long-term results of surgical correction for this malformation depend upon the degree of preoperative pulmonary vascular disease and upon the amount of residual AV valve regurgitation. If the pulmonary vasculature is protected and the amount of valvular regurgitation is reduced substantially, prognosis is good. When severe pulmonary vascular disease is present preoperatively, morbidity and mortality rates are high. Complete heart block and arrhythmias may occur after correction, and their incidence increases with age. As the patient grows older, mitral valve replacement may be needed.

The surgical mortality rate in patients with partial endocardial cushion defects is 0-6%, while that for the complete defect ranges from 3-10%.

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Patient Education

Parents must be instructed to ensure that antibiotic prophylaxis for dental procedures is instituted for the child. Good dental hygiene for the child is imperative.

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