Impact of preoperative diagnosis of congenital heart disease on the treatment of esophageal atresia

Abstract

Congenital heart disease (CHD) has a major impact on the survival of babies with esophageal atresia (EA). The present study assesses whether early diagnosis influences the management strategies in a large series of EA. Cases of EA treated between 1982 and 2002 were retrospectively divided into groups according to the presence or absence of CHD and to whether this was diagnosed or not prior to tracheo-esophageal fistula repair. Patients were also staged according to Spitz's classification in which major congenital heart disease (MCHD) are those associated with cyanosis and/or heart failure requiring surgery. Comparisons between groups of patients were made by standard statistical tests. Among 195 babies with EA (99 boys and 96 girls), 82 (42%) had CHD (31 boys, 39% and 51 girls, 61%, chi2 P < 0.05) and 43 out of these 82 (52%) had MCHD. Six children died without treatment. CHD was diagnosed prenatally in six cases and before EA repair in 26 cases. The diagnoses were missed in 12 instances (in five it was a MCHD). Regardless of preoperative diagnosis of right aortic arch in 3/6 cases, the oesophagus was approached from the right thorax in all cases and only in one of them the operation was not completed due to hemodynamic instability. There were 145/195 (75%) Spitz group I patients; 44/195 (22%) were group II and 6/195 (3%) group III. The mortality was respectively 9.5, 59 and 83%. We lost 15/113 (13%) babies with EA without CHD, 4/39 (10.2%) with EA and CHD and 26/43 (60%) with EA and MCHD. In children with CHD diagnosed prior to the esophageal operation 8/26 (30.7%) died and among those without diagnoses 3/12 (25%) died, (chi2 P> 0.1). 1. CHD was diagnosed after EA repair in one-third of cases. 2. Preoperative diagnosis of CHD changed the operative indication only in one case. 3. Survival after treatment for EA was not influenced by the moment or the accuracy of the diagnosis of CHD in this series. 4. With only a few exceptions, associated CHD should not change the strategies of EA repair.

Developing a new predictive index for anastomotic leak following the anastomosis of esophageal atresia: preliminary results from a single centre

“…More interestingly, survival after treatment for EA was not influenced by the presence of, or the accuracy of, the diagnosis of CHD in this series. With only a few exceptions, associated CHD should not change the strategies of EA repair [ 19 ].…”

Current profile and outcome of 100 esophageal atresia patients in the Kyushu area of Japan

“…However, the numbers of patients who had chromosomal abnormalities were relatively higher in this study, it might be difficult to compare. According to treatment strategy for the EA with CHD, Encinas et al documented the low rate of diagnose for the cardiac anomalies before EA operation and showed relatively higher mortality in Spitz classification [10]. And Hayashi et al described the treatment strategy for their 6 EA patients with CHD.…”

“…Recent reports have documented that the predictors for adverse outcome changed, with cardiac anomalies becoming the most important risk factor [3,6,9,10]. And other reports have stated that the birth weight <1500 g showed no significant difference when compared to the patients with birth weights >1500 g [6].…”

Congenital Heart Disease and Its Impact on the Development of Anastomotic Strictures after Reconstruction of Esophageal Atresia

“…Congenital heart disease (CHD) constitutes a spectra of cardiac malformations reported to occur in one-third of children with esophageal atresia (EA) [ 1 ]. Severe types of CHD are reported to be present in 10% of patients with EA and seem to impact on their survival [ 1 , 2 ].…”

“…Congenital heart disease (CHD) constitutes a spectra of cardiac malformations reported to occur in one-third of children with esophageal atresia (EA) [ 1 ]. Severe types of CHD are reported to be present in 10% of patients with EA and seem to impact on their survival [ 1 , 2 ]. Anastomotic strictures (AS) reportedly occur in 9–79% [ 3 – 8 ] of newborns after reconstruction of EA, and hypo-oxygenation of the tissue has been recognized to be one risk factor for development of AS [ 3 ].…”