Unequal cardiac care for children with Down's syndrome
H. M. Sondheimer, C. J. Byrum and M. S. Blackman
We reviewed the course of all 36 new patients with complete
atrioventricular canal defect (CAVC) seen in a regional center from 1977
through 1982. Of this group of 36 patients, 28 had Down's syndrome. The
eight children without Down's syndrome were all referred before 1 year of
age. Surgical intervention was possible for each child. Of the 28 with
Down's syndrome, 18 were referred before 1 year of age. Surgery
intervention was possible in 17 (94%) of 18. Of the ten children with
Down's syndrome referred after 1 year of age, surgical therapy was not
possible in five because of pulmonary vascular obstructive disease (PVOD).
Since CAVC is known to progress to PVOD at an early age, it is not
surprising that half of those patients referred after 1 year of age had
become inoperable because of this complication. We therefore concluded that
in spite of the severity of CAVC some children with Down's syndrome and
this heart condition are being denied standard cardiac care by the process
of late referral.
