A 3-month-old infant with Down syndrome presents with tachypnoea and poor feeding. Echocardiography reveals a complete atrioventricular septal defect (AVSD). Surgery is best planned at what age to prevent irreversible pulmonary hypertension?
- A First 2 weeks of life
- B 12–18 months of age
- C 3–6 months of age ✓
- D After 2 years when surgical risk is lower
Correct answer: C. 3–6 months of age
Explanation
Complete AVSD in Down syndrome carries a high risk of early pulmonary hypertension due to increased pulmonary blood flow; repair is recommended at 3–6 months of age to prevent Eisenmenger syndrome, which develops earlier and faster in trisomy 21. Delaying surgery beyond 6 months significantly increases the risk of irreversible pulmonary vascular disease. Neonatal repair carries prohibitively high risk without emergent indications.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.