a 3-day - old neonate who was born 1,530 g at 39 prenatal weeks was diagnosed with a ventricular septal defect , a patent ductus arteriosus , and a coarctation of aorta . other vital signs were normal except for a high respiration rate of 65 breaths per minute . besides the diagnoses above , an aortic arch hypoplasia was discovered by echocardiography ( ascending aorta 6 mm , first aortic arch 3.72 mm , second aortic arch 2.90 mm , isthmus 1.83 mm ) . the flow of blood through the patent ductus arteriosus was from right to left in systole , and from left to right in diastole . there were a large ventricular septal defect in the perimembranous trabeculation and a small atrial septal defect . the patient was medicated with prostaglandin e1 to delay the operation and observed in the neonatal intensive care unit . at 7 days old , we decided to do operation because the symptoms of heart failure , including tachypnea and oral feeding difficulty , had become worse . on the operation day , the patient 's age was 9 days and weight was 1,480 g. a cardiopulmonary bypass ( cpb ) machine by cobe century , oxygenator by terumo rx-05 , line by hanmi ( a line 1/4 , v line 1/4 ) , and hemofiltration machine by dideco were used . the volume of the priming fluid in the cardiopulmonary bypass machine was 605 cc ( plasma solution 330 cc , 20% albumin 50 cc , rbc 200 cc , bivon 20 cc , and mannitol 5 cc ) . an 8-fr cannula was inserted into the aorta and a 4-fr intravenous cannula was inserted into the right atrium . a 14-fr intravenous cannula was inserted into the inferior vena cava , and a 10-fr vent cannula was inserted into the right upper pulmonary vein . an 18 g pediatric aortic root cannula ( dlp medtronic ) was inserted into the proximal aorta ; then the cardioplegia solution was injected after the upper part of the ascending aorta was clamped . then the patch closure with glutaraldehyde - fixed auto pericardium was performed for the repair of the ventricular septal defect . after the incised right atrium was sutured , the left common carotid artery and the left subclavian artery were ligated temporarily . the rectal temperature was 25.9 , and the perfusion rate was 90 ml / min . the cerebral perfusion pressure was not observed due to the failure of the maintenance of the a - line in the right radial artery . after dissection of the aortic arch , cerebrovascular artery , and descending aorta , removal of part of the coarctation was performed . extended end - to - side anastomosis between the descending aorta and the aortic arch was performed . after untying the ligation of the left common carotid artery , the left subclavian artery , and the ascending aorta , the body temperature was increased while maintaining the perfusion rate of the cpb at 300 ml / min and the perfusion pressure at 45 - 55 mmhg . the cpb weaning was successful , and norepinephrine 0.08 ug / kg / min , dobutamine 5 ug / kg / min , dopamine 5 ug / kg / min , and milrinone 0.75 ug / kg / min were administered . the total cpb time was 120 min and aortic cross clamp time was 67 min . the patient recovered hemodynamic stability in the cardiovascular intensive care unit ( icu ) , and was weaned from the ventilator 3 days after the operation . the patient was transferred to the neonatal icu on postoperative day 7 , and discharged 1 month postoperatively . at the last follow - up , the patient 's age was 76 days old and weight was up to 3.1 kg . it has been reported that one - stage complete repair for prematurity with congenital heart diseases or neonates with low birth weight resulted in more growth and lower mortality than palliative repair in many studies . however , even in hospitals with a great deal of experience , age and weight of neonates are major risk factors for cardiac surgery [ 1 - 4 ] . in particular , most surgeons are reluctant cardiac surgery in neonates with low birth weight ( 2.5 kg ) can be complicated because of the difficulty of cardiopulmonary bypass management , occurrence of frequent complications including cerebral hemorrhage , difficult surgical technique due to poor surgical field and weak tissue [ 3 - 5 ] . even when cardiac surgery has been performed successfully , cardiac surgery is carried out with more risk in neonates with very low birth weight ( 1.5 kg ) because most organ systems are immature . the likelihood of hypocalcemia due to a low concentration of ionized calcium caused by depletion of skeletal calcium is high . perhaps most importantly in this population , cardiovascular and pulmonary immaturity make the postoperative management of infants who are in a physiologically transitional stage from fetus to neonate somewhat unpredictable . in addition , using the cardiopulmonary bypass can frequently cause complications related to the lungs because the possibility of an inflammation reaction are increased by immature lung function . therefore , it is important to use the minimum amount of priming volume in the cardiopulmonary bypass [ 4 - 6 ] . kim et al . reported a case of cardiac surgery for a coarctation of aorta with a ventricular septal defect using 150 cc priming volume in a low birth weight neonate of 1,250 g. the minimum amount of the priming volume in the cardiopulmonary bypass is especially important in low birth weight neonates . in the case of the patient in this study , although the modified ultrafiltration was performed after weaning from the cardiopulmonary bypass , the weight of the patient increased 200 g after the operation because of the priming volume of 605 cc was too much . management of the patient was difficult after operation because edema caused by an inflammation reaction occurred . therefore , we think that we need to more effort for decreasing of the amount of the priming volume . this study is the only report of one - stage complete repair of the ventricular septal defect and the coarctation of aorta after kim et al . therefore , we report here on a successful case of early one - stage total repair of coarctation of aorta and ventricular septal defect in a 1,480 g neonate .
although outcomes of neonatal cardiac surgery have dramatically improved in the last two decades , low body weight still constitutes an important risk factor for morbidity and mortality . in particular , cardiac surgery in neonates with very low birth weight ( 1.5 kg ) 
 is carried out with greater risk because most organ systems are immature . 
 we report here on a successful case of early one - stage total repair of coarctation of the aorta and a ventricular septal defect in a 1,480 gram neonate .