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We reviewed our experience to examine the outcomes of noncardiac surgery in neonates with congenital cardiac defects and assess future changes in the management of noncardiac surgery in neonates for whom new cardiac surgical management strategies will develop based on current progress in prenatal diagnosis. Forty-five neonates with congenital cardiac defects underwent noncardiac surgery in our institution. Subsequent cardiac surgery was performed in 26 of those neonates. No patient underwent cardiac surgery before noncardiac surgery. However, rescue neonatal cardiac surgery, which is performed within 24 h after birth, has become more common because of the progress in prenatal diagnosis. Under these circumstances in neonatal cardiac surgery, the timing or approach of cardiac and noncardiac surgery should be reconsidered in the next few years. We emphasize the importance of cooperation among relevant specialists in the management of neonates with multiple disorders to increase the benefits offered by developments in prenatal diagnosis.

Pulmonary hypertension is the most serious complication with the infants of chronic lung disease and pulmonary hypertension. There were no evaluating methods available for outpatients. We've made the scoring system from seven parameters of echocardiography which consist of RSTI, AT/ET, LV (S/L), RVaw (d), RVaw (s), P/A, T/M. The points of total PH score are correlated with estimated pulmonary arterial pressure from the maximum velocity of tricuspid regurgitation. The infants of points less than 2 are considered no PH, points 2 to 4 are mild PH, points 5 to 8 are moderate PH, points more than 8 are severe hypertension. The system has revealed useful for management of patients with home oxygen therapy.

To evaluate exercise capacity in ischemic heart disease, we measured the peak aortic flow velocity by continuous wave Doppler (CWD) echo from the suprasternal notch at rest and during multiple load ergometer testing in the supine position. The study subjects consisted of 14 normal controls, 10 patients with effort angina and 21 patients with old myocardial infarction (OMI). In all the patients and in five normal subjects, thallium-201 emission CT (SPECT) was also performed immediately after exercise and four hours subsequently. Change in the peak aortic flow velocity during exercise was compared with the extent of perfusion defects and the presence or absence of redistribution images on SPECT. At rest, the peak aortic flow velocity was not different from that of the other three groups. During exercise, it increased progressively (crescendo type) as the exercise was increased in normal subjects. In patients with angina pectoris it increased at the initial stage of exercise, but was unchanged (crescendo-plateau type) or decreased (crescendo-decrescendo type) at the maximum exercise stage. Redistribution images on SPECT were seen in nine of 10 patients with angina pectoris. In patients with OMI, change in the peak aortic flow velocity was of the crescendo type in 14, crescendo-decrescendo in three and crescendo-plateau in one. In the remaining three it decreased from the beginning of exercise (decrescendo type). Redistribution images were seen in all patients with the crescendo-decrescendo, crescendo-plateau or decrescendo types. Furthermore, myocardial damage was much more extensive in the decrescendo type. We conclude that exercise continuous wave Doppler echocardiography is a useful means of evaluating exercise capacity in ischemic heart disease.