The effect of changing attitudes to Down's syndrome in the management of complete atrioventricular septal defects

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Abstract
OBJECTIVES To describe the evaluation, decision making, and care of children with a complete atrioventricular septal defect (CAVSD). STUDY DESIGN Retrospective study of 136 consecutive cases from 1970 to 1996. RESULTS A total of 115 (85%) children had Down’s syndrome. Denial of surgery without obvious medical reasons was more common in the early years, as was parental refusal of offered surgery and institutional care of the children. Improved results in later years encouraged surgical treatment for all these patients, but more liberal attitudes towards patients with Down’s syndrome preceded the improved results. The use of echocardiography as a screening method for all newborns with Down’s syndrome made it possible to plan for correction within the 1st months of life. CONCLUSIONS Changing attitudes in society and widespread use of echocardiography have significantly improved the management of children with a CAVSD and Down’s syndrome. Attitudes towards evaluating and offering surgery to Down’s syndrome patients have changed Echocardiography has made it possible to screen all children with Down’s syndrome within weeks of birth Younger age at diagnosis improves the chances of successful surgery while pulmonary hypertension is still reversible Echocardiography has decreased the role of catheterisation as a preoperative investigation method