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Second Congress of Cardiology and Angiology of Bosnia & Herzegovina

 

EARLY REPAIR AS A MODERN STRATEGY IN CONGENITAL HEART DEFECTS: WHY AND WHEN?
G. Wollenek
Department of Cardiothoracic Surgery, University and General Hospital Vienna, Vienna, Austria

In pediatric cardiac surgery there is a general trend towards early repair, thus avoiding palliative procedures and long-term sequelae, e.g. in tetralogy of Fallot, ventricular and atrioventricular septal defect. In some other malformations, the physiology requires very early intervention, e.g. in transposition of the great arteries an arterial switch procedure should be performed within the first two weeks of live. Our experiences with these groups of patients (120 arterial switch procedures, all neonates, 80 AVSD, 450 isolated ventricular septal defects and 400 tetralogy of Fallot, 10 % of them infants) are analyzed with regard to indications and contraindications, as well as results, thereby comparing the age group of neonates and infants with other age groups. Mortality rates for infants are significantly lower than compared with the historical group of patients, and reasonable compared with a mortality rate of 0 % in children older than one year. Contraindications include i.e. complex anatomy, severely hypoplastic pulmonaries, and the need for conduits. Age and weight are no contraindication: at repair the younges patients were newborn, the minimum weight 1.800 g for VSD and TGA, 3.000 g for Fallot and AVSD. So in congenital heart defects, even in the asymptomatic child, there has to be strived for early repair, regardless of off age and weight, but with cautious individual risk evaluation. This trend may continue: nowadays the prenatal echocardiography reveals cardiac malformations in a very early state, As a consequence, fetal cardiac surgery could be developed as an therapeutic alternative for unborn developing hypolastic left heart syndrome. In a series of animal experiment we have proven the technical feasibility. Still further studies and significant improvements in technical details and safety margins are required before a realization in human medicine could be taken into consideration. But as least as important are the ethical, religious and socio-economical questions with this development.

Drugi kongres kardiologa i angiologa Bosne i Hercegovine
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