INFLUENCE OF CONGENITAL HEART-DISEASE ON MANAGEMENT OF ESOPHAGEAL ATRESIA

Congenital heart disease (CHD) is the commonest abnormality associated with oesophageal atresia, occurring in about 20% of cases. Echocardiography should be performed prior to repair of the atresia to identify CHD and lateralise the aorta. Knowledge of the anatomical type and physiological consequences of the CHD enables a co-ordinated plan of management. In patients who are non-duct-dependent for systemic or pulmonary blood flow the oesophagus can be repaired early while pulmonary vascular resistance is high; definitive treatment of the CHD is undertaken later. Duct-dependent lesions usually can be temporarily palliated with prostaglandin E1 infusions commenced prior to repair of the atresia. It is extremely rare that palliative or reparative cardiac surgery is required prior to division of the tracheo-oesophageal fistula and repair of the oesophageal atresia.