The incidence of CHD is estimated to be between 5 and 8 per 1000 live births, and many will require surgical interventions ,while sixty-nine percent 69% of all Atrial Ventricular Defects have Down syndrome, The Ebstein`s malformation mortality in children presenting in the neonatal period is 30 - 50%,mortality is higher with severe right Atrial enlargement,, right ventricular dysplasia ,and it is noted that mortality rate is higher in patients with other associated congenital heart diseases ,when presentation is in infancy and with severe cyanosis or congestive heart failure.(22,23).The incidence of admitted neonatal and children patients with Dawn syndrome and requiring surgical interventions at Cincinnati Medical Center, Ohio .USA, and their ages ranged between (6 months-7 years old)from October 2000 until May 2004 it was 1256 .(24).The admitted patients with Down syndrome and requiring surgical repairs at The National Institute for Heart . Cairo, Egypt from February 2001 until September 2004 it was 420 patients their ages ranged between (2 - 6 years old) (25).

Back, neck and low shoulder pain often occurs after surgery, this discomfort can be relieved with a heating pad set for a 10 - 15 min, 3 to 4 times a day, do not use on Incisional areas, heating pads should not be used for diabetic patients, and application of cardiac rehabilitation program followed by home care instruction to the parents reduce limitation and improve the level of independence.(26).