Tion and detailed cardiac examination of newborns with down syndrome has resulted in earlier diagnosis and prompt management [5]. Surgery before 1 year is associated with a better outcome [6]. Increasingly, avsd repair is performed without prior pab [2, 6]. Apart from difficulty in band removal, prior pab has been associated with higher operative mortality [3]. low cost viagra uk Initial palliation with pab in avsd patients reached borderline significance for reoperation (p = 0. 07) in our study. viagra for sale Other studies have not found this to be the case [7]. cheap generic viagra online In patients with uncontrollable heart failure, our policy is to perform correction rather than palliation. Generally in the united kingdom, it is accepted that these defects should be repaired before 6 months of age. In our unit, we choose to undertake repair between 3 and 6 months for organizational reasons and because of some evidence that infants recover from heart surgery better between 3 and 6 months rather than between 1 and 3 months [8]. cheap viagra online Left av valve regurgitation is the most common reason for reoperation after avsd repair [9, 10]. In our series, this accounts for 60. 5% of all reoperations. We believe that this is because of the morphology of the valve and its physiology at surgery. what's the difference between viagra and viagra We have shown that the outcome is worse if there is failure secondary to lavvr preoperatively with unbalanced avsd. Reconstruction of lavv is more challenging in infants younger than 3 months compared with older children, and technical improvements in avsd repair have been offset by younger age at correction. buyviagraonlinediscountcoupons.accountant Some studies [11, 12] have shown that avsd repair in infants younger than 6 months may lead to reduced incidence of lavvr by minimizing annular dilatation and slowing degeneration. In contrast, bonnetts and colleagues [13] found that there was a higher risk of significant lavvr in patients in whom primary repair was performed at younger than 4 months of age. viagra buy Although age was not statistically significant in our analysis, 10 cavsd patients (83. 3%) who required a reoperation for lavvr were younger than 4 months old at repair. Three patients had unbalanced avsd with small lavv and highly dysmorphic valves in whom satisfactory repair was not achieved. Patients were given a trial of medical management to allow growth pending planned reoperation. Early reintervention and mvr was adopted in these cases. In all cases, intraoperative transthoracic echocardiographic was performed by pediatric cardiologists. Initial excellent repair deteriorated during the hospital stay in 5 patients. do i need a doctor's prescription for viagra At reoperation, laceration of the bridging leaflets was found to be the main problem. low cost viagra uk Usually, this was parallel to the cleft or to the line of septation. We believe that the high reoperation rate is attributable to the fact that we operated on a small number of "hopeless" valves. This is reinforced by the intraoperative finding of "tethering and rolling," which was significant for reoperation. Furthermore, with our aggressive reoperation policy, we ha. buy generic viagra using paypal Trustar Diamonds
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