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New trends in the management of congenital heart disease

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Abstract

Considerable improvements have been made in the diagnosis and treatment of congenital heart disease during the last decade. Many congenital heart lesions are now treated successfully during the neonatal period that previously were associated with high mortality. Improved echocardiographic imaging, catheterization techniques, and earlier surgical repair are factors that have resulted in greater success in the treatment of congenital cardiac disease. Diagnosis has been improved greatly with advancements in echocardiography and angiography. Better ultrasound technology combined with doppler techniques and transesophageal echocardiography allow more accurate preoperative assessment and therefore more successful surgical repair. Cardiac catheterization techniques have also improved and, when combined with treatment such as balloon angioplasty, have changed the treatment of certain cardiac anomalies such as pulmonary stenosis or coarctation of the aorta. Operative treatment of congenital heart disease has improved the short- and long-term survival of most infants with congenital cardiac anomalies. Improved cardiopulmonary bypass techniques, better suture material, and the ability to perform cardiac transplantation are examples of technology that allows earlier, more complete repair of these complex cardiac defects. Reviewed here are improvements in the treatment of four complex cardiac anomalies that occur in newborns and are associated with high mortality when left untreated. All four anomalies have undergone significant changes in the approach to their treatment with dramatic improvements in survival.

Résumé

Pendant la dernière décennie, de grands progrès ont été faits dans le domaine du diagnostic et du traitement des maladies cardiaques congénitales. Autrefoia d'un pronoctic redoutable, beaucoup d'entre elles sont traitées à présent avec succès dans la période néonatale. Le diagnostic de ces anomalies a été grandement facilité par: 1) l'amélioration des moyens d'imagerie comme l'échocardiographie, qu'elle soit simple, couplée avec un examen Doppler ou encore pratiquée par voie transoesophagienne, et comme l'angiographie; 2) une meilleure technique de cathétérisation, combinée éventuellement avec l'angioplastie par ballonnet; 3) des indications chirurgicales plus précoces; et enfin, 4) des nouvelles techniques (par exemple les techniques de circulation extra-corporelle) et de nouveaux matériaux de sutures chirurgicales. On passe en revue ici les anomalies les plus fréquemement rencontrées dans la période néonatale, c'est à dire la transposition des gros vaisseaux, les veines pulmonaires anormales, et toutes les variétés de sténoses aortiques. Le rôle de la transplantation cardiaque est abordé.

Resumen

En el último decenio se han logrado avances de consideración en el diagnóstico y el tratamiento de la enfermedad cardíaca congénita. Muchas lesiones cardíacas congénitas son tratadas hoy en forma exitosa en el período neonatal, cuando previamente exhibían alta mortalidad. Mejores imagenología, ecocardiografía y cateterismo cardíaco, y la reparación quirúrgica precoz, son todos factores que aportan al mayor éxito en el tratamiento.

El diagnóstico ha avanzado notoriamente en cuanto a ecocardiografía y angiografía. Las mejores técnicas de ultrasonido combinadas con tecnología de Dopplar y ecocardiografía transesofágica permiten una certera valoración preoperatoria y, por consiguiente, mayor éxito en la reparación quirúrgica. Las técnicas de cateterismo cardíaco también han avanzado, y cuando se combinan con la angioplastia de balón, modifican sustancialmente el tratamiento de ciertas anomalías como la estenosis pulmonar o la coartación de aorta.

El tratamiento operatorio de la enfermedad cardíaca congénita ha incrementado las tasas de sobrevida a corto y a largo plazo en la mayoría de los pacientes con anomalías congénitas. Las mejores técnicas de perfusión extracorpórea, los nuevos materiales de sutura y la capacidad para realizar transplante cardíaco, son ejemplos de las tecnologías de avanzada que hacen posible una reparación más pronta y más completa de estos complejos defectos cardíacos.

La presente revisión enumera los avances en el tratamiento de cuatro complejas anomalías cardíacas que ocurren en el período neonatal y que se asocian con una extremadamente alta mortalidad al dejarlas sin tratamiento.

En el aproche a tales cuatro anomalías se han producido cambios significativos en cuanto a tratamiento, con dramático incremento en la sobrevida. Se espera que esta revisión aporte al lector una apreciación de los mayores avances logrados en el manejo de estas complejas lesiones.

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Correspondence to Mark W. Turrentine M.D..

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Heimansohn, D.A., Turrentine, M.W., Kesler, K.A. et al. New trends in the management of congenital heart disease. World J. Surg. 17, 356–362 (1993). https://doi.org/10.1007/BF01658704

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Keywords

  • Congenital Heart Disease
  • Cardiac Anomaly
  • Catheterization Technique
  • Complete Repair
  • Congenital Cardiac Anomaly