Successful Staged Managements for Extremely Low Birth Weight Infants with Congenital Heart Disease and Pulmonary Overcirculation - Four Case Reports

Abstract

Background: Recently the outcome of extremely low birth infants （ELBWI）has been improving, whereas the reports of treatment are still limited for those with complications of congenital heart disease. We report four cases of ELBWI who successfully underwent corrective cardiac surgery for congenital heart disease with pulmonary overcirculation.
Case: 1）Atrial septal defect: Gestational Age （GA）29 weeks, birth weight （BW）504 g. A female infant developed pulmonary hypertension at 2 months of age, which was treated with oral sildenafil. The defect was closed at 4 months. 2）Complete atrioventricular septal defect: GA 26 weeks, BW 670 g. A Trisomy 21 male infant who underwent pulmonary artery banding at 2 months. Corrective surgery was performed at 4 months. 3）Ventricular septal defect: GA 27 weeks, BW 412 g. A male infant presented with severe pulmonary hypertension at 5 months. He was treated with oxygen and sildenafil, subsequently underwent surgical closure at 10 months of age. 4）Truncus arteriosus: GA 29 weeks, BW 752 g. A girl underwent bilateral pulmonary artery banding at 7 months. After being optimized with oxygen therapy, sildenafil, and beraprost, she underwent corrective surgery at the age of 25 months.
Conclusion: Extremely low birth weight patients with congenital heart disease and pulmonary overcirculation can be successfully treated by intensive control of pulmonary blood flow and pulmonary hypertension. Surgery should not be delayed for premature infants with congenital heart disease, who might benefit from early and aggressive treatment.