Open-heart surgery in the first year of life

Open-heart surgery may be required very early in life in two main groups of patients. In the first, operation is performed as a life-saving, often emergency, procedure for severe hypoxaemia, intractable heart failure or for a combination of both. Typical of this emergency group are infants with total anomalous pulmonary venous drainage (TAPVD) for whom the mortality rate without treatment is 85% during the first years of life. In the second group, operation is performed early in life because the prognosis without treatment, or even after palliative treatment, is unfavourable. The best example of the second group are infants with transposition of the great arteries (TGA). Balloon septostomy or surgical septectomy improved an otherwise unfavourable prognosis but thromboembolic episodes and the early development of pulmonary vascular disease present life-threatening complications.