The Limits Of Early Mobilization After Cardiac-Surgery From The Viewpoint Of The Pediatric Cardiologist

Early mobilization after cardiac surgery in children may be limited by various postoperative problems. These are mainly congestive heart failure, respiratory insufficiency, general or local infections, postoperative cardiac arrhythmias, and a number of other postoperative complications.We examined the postoperative course of 297 children operated in the period 1986 - 1989 for congenital defects of the heart and great vessels. Fifty of these patients were new-borns, 92 were infants, 98 young children, and 57 schoolage children. In 37% of the patients, no postoperative problems were observed; 31% had problems without prolongation of hospitalization, and 32% developed problems which delayed discharge from hospital.Further analyzed was the postoperative course of patients after closure of a patent ductus arteriosus (19), correction of aortic coarctation (39), secundum atrial septal defect (26), ventricular septal defect (46), and complete atrio-ventricular canal (15), construction of a Blalock-Taussig-anastomosis (19) or a central aortopulmonary shunt (9), correction of Fallot's tetralogy or pulmonary atresia with ventricular septal defect (25), correction of simple complete transposition of the great arteries by the arterial switch-operation (25) or a Senning-procedure (27), and finally, after a Fontan-Operation (9). We found, as expected, that patients after operation of simple cardiovascular defects had few postoperative complications and could be mobilized early and discharged. In contrast, patients after operation of complex cardiac defects frequently developed postoperative problems which delayed early mobilization and discharge. Newborns, infants, and young children regulate their own degree of mobility and, as a rule, behave adequately in this respect. Older children sometimes must be encouraged to move more or, to the contrary, must be restrained from too early or too strenuous movement.