The Journal of Thoracic and Cardiovascular Surgery, Vol 81, 227-231, Copyright © 1981 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
Prostaglandin E1 as an adjunct to emergency cardiac operation in neonates
JS Donahoo, JM Roland, J Kan, TJ Gardner and BS Kidd
Prostaglandin E1 (PGE1) has been used prior to operation in 28 neonates (0
to 30 days) with congenital heart disease (CHD). The patients were divided
into two groups. Group I consisted of 19 neonates with CHD resulting in
marked cyanosis. Thirteen patients had pulmonary atresia, three had
tetralogy of Fallot, and three had complex defects with pulmonary stenosis.
All patients were markedly hypoxemic. The average oxygen saturation was
41%. PGE1 infusion, 0.1 mcg/kg/min, was successful in 17 of 19 patients, as
it resulted in an increase in oxygen saturation from 41% to 79%, average
increase 38%. Two patients did not respond to PGE1 infusion. One was 30
days of age and the other had no patient ductus arteriosus. All of the
patients underwent a palliative shunt procedure. There were three hospital
deaths in this group. No patient died of hypoxemia. Group II consisted of
nine patients whose CHD was predominantly that of aortic obstructive
disease with clinical manifestations of cardiac failure, hypoperfusion, and
acidemia. Six of these patients had complicated coarctation of the aorta.
Three patients had interruption of the aortic arch. The pH of these
patients averaged 7.19. PGE1 infusion resulted in improvement of the pH to
average of 7.37, improvement of congestive heart failure, and reappearance
of femoral pulses. One patient failed to respond. All patients in Group II
underwent operation. There were three hospital deaths in this group. No
patient died intraoperatively. PGE1 infusion is a valuable aid to surgical
treatment of desperately ill neonates with both cyanotic and acyanotic
forms of CHD.
