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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References
Arciniegas. Pediatric Cardiac Surgery. Chicago, Year Book 1985.
Liebman, J., Lullum, L., Bellog, N.B.: Natural history of transposition of the great arteries: anatomy and birth and death characteristics. Circulation40:237, 1969
Sabiston and Spencer.: Surgery of the Chest. Philadelphia, Saunders, 1990
Jatene, A.D., Fontes, V.F., Paulista, P.P., et al.: Successful anatomic correction of transposition of the great vessels: a preliminary report. Arg. Bras. Cardiol.28:461, 1975
Losay, J., Planche, C., Gerardin, B., Lacour-Gayet, F., Bruniaux, J., and Kachaner, J.: Midterm surgical results of arterial switch operation for transposition of the great arteries with intact septum. Circulation82(Suppl. IV): 146, 1990
Planche, C., Bruniaux, J., Lacour-Gayet, F., et al.: J. Thorac. Cardiovasc. Surg.96:354, 1988
Yamaguchi, M., Hosokawa, Y., Imaai, Y., et al.: Early and midterm results of the arterial switch operation for transposition of the great arteries in Japan. J. Thorac. Cardiovasc. Surg.100:261, 1990
Jex, R.K., Puga, F.J., Julsrud, P.R., Weidman, W.H.: Repair of transposition of the great arteries with intact ventricular septum and left ventricular outflow tract obstruction. J. Thorac. Cardiovasc. Surg.100:682, 1990
Backer, C.L., Ilbawi, M.N., Ohtake, S., et al.: Transposition of the great arteries: a comparison of results of the Mustard procedure versus the arterial switch. Ann. Thorac. Surg.48:10, 1989
Kirklin, J.W., Colvin, E.V., McConnell, M.E., Bargeron, L.M.: Complete transposition of the great arteries: treatment in the current era. Pediatr. Clin. North Am.37:171, 1990
Norwood, W.I., Dobell, A.R., Freed, M.D., Kirklin, J.W., Blackstone, E.H., and the Congenital Heart Surgeons Society: Intermediate results of the arterial switch repair: a 20-institution study. J. Thorac. Cardiovasc. Surg.96:854, 1988
Danford, D.A.: Factors influencing choice of procedure in transposition of the great arteries: a decision analysis approach. J. Am. Coll. Cardiol.16:471, 1990
Corno, A., George, B., Pearl, J., Laks, H.: Surgical options for complex transposition of the great arteries. J. Am. Coll. Cardiol.14:742, 1989
Jonas, R.A., Giglia, T.M., Sanders, S.P., et al.: Rapid, two-stage arterial switch for transposition of the great arteries and intact ventricular septum beyond the neonatal period. Circulation80(Suppl. I):203, 1989
Muller, W.H., Jr.: The surgical treatment of transposition of the pulmonary veins. Ann. Surg.134:683, 1951
Sano, S., Brawn, W.J., Mee, R.B.B.: Total anomalous pulmonary venous drainage. J. Thorac. Cardiovasc. Surg.97:886, 1989
Lamb, R.K., Qureshi, S.A., Wilkinson, J.L., Arnold, R., West, C.R., Hamilton, D.I.: Total anomalous pulmonary venous drainage. seventeen-year surgical experience. J. Thorac. Cardiovasc. Surg.96:368, 1988
Jaumin, P., Rubay, J., Moulin, D., et al.: J. Cardiovasc. Surg.30:11, 1989
Trinkle, J.K., Grover, F.L., Arom, K.V.: Closed aortic valvotomy in infants. J. Thorac. Cardiovasc. Surg.76:198, 1978
Trinkle, J.K., Norton, J.B., Richardson, G.D., et al.: Closed aortic valvotomy and simultaneous correction of associated anomalies in infants. J. Thorac. Cardiovasc. Surg.69:758, 1975
Brown, J.W., Stevens, L.S., Holly, S., et al.: Surgical spectrum of aortic stenosis in children: a thirty-year experience with 257 children. Ann. Thorac. Surg.45:393, 1988
Kriett, J.M., Kaye, M.P.: The Registry of the International Society for Heart and Lung Transplantation: eighth official report-1991. J. Heart Lung Transplant.10:498, 1991
Bailey, L.L., Nelson-Cannarella, S.L., Doroshow, R.W.: Cardiac allotransplantation in newborns as therapy for hypoplastic left heart syndrome. N. Engl. J. Med.315:949, 1986
Bailey, L.L., Concepcion, W., Shattuck, H., Huang, L.: Method of heart transplantation for treatment of hypoplastic left heart syndrome. J. Thorac. Cardiovasc. Surg.92:1, 1986
Bove, E.L.: Transplantation after first-stage reconstruction for hypoplastic left heart syndrome. Ann. Thorac. Surg.52:701, 1991
Pennington, D.G., Noedel, N., McBride, L.R., et al.: Heart transplantation in children: an international survey. Ann. Thorac. Surg.52:710, 1991
Chartrand, C.: Pediatric cardiac transplantation despite atrial and venous return anomalies. Ann. Thorac. Surg.52:716, 1991
Menkis, A.H., McKenzie, F.N., Novick, R.J., et al.: Expanding applicability of transplantation after multiple prior palliative procedures. Ann. Thorac. Surg.52:722, 1991
Starnes, V.A., Bernstein, D., Oyer, P.E., et al.: Heart transplantation in children. J. Heart Transplant.8:20, 1989
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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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DOI: https://doi.org/10.1007/BF01658704