Female Newborn Patient with Significant Cardiac Malformation, Partial Duplication of Left Foot and Recto-vestibular Fistula

Case Summary

• Female newborn with significant cardiac malformation (single ventricle physiology, aortic atresia, dysplastic pulmonary valve), partial duplication of the left foot, and recto-vestibular fistula
• POINTS FOR DISCUSSION:
  • Time of operation for the anorectal malformation
  • Time of operation for the foot
  • Patient will need a heart transplant to survive outside the hospital

Takeaways

• SURGICAL BUY-IN
• Concept that when a patient consents to surgery they are also promising to endure intensive treatments in the post operative period if necessary
  • Dialysis, prolonged ventilation, feeding tubes
  • Immunosuppression
• SURGICAL PALLIATIVE CARE
  • In medically complex patients, they often meet surgeons at a fork in the road
    • Continue to pursue more intensive treatment
    • Focus on comfort or set limits on scale of interventions
  • Help prepare patients for a variety of outcomes
• DETERMINE GOALS OF CARE
  • What are you most worried about?
  • What are you hopeful for?
  • What are you expecting to happen?
  • Is there any health status that would be unacceptable to you?
• Use your clinical expertise to determine what reasonable options would be
• Determine your patient and their families value systems
  • What is important to them
• Make a recommendation