Ethical issues concerning cardiac surgery in patients with syndromic abnormalities

Advances in surgical techniques, cardiac anesthesia, and pre- and postoperative care have made the surgical treatment of complex congenital cardiac disease available to an ever-increasing number of children, including those with a wide range of extracardiac anomalies. Over the past few decades cardiac surgery in infants and children with syndrome-associated physical and mental conditions has undergone a remarkable change, with previously held norms abandoned for new standards. The social, ethical, and clinical appropriateness of these changes has been the focus of much attention. In this article, we provide a brief history of cardiac surgery in children with congenital syndromes, discuss some groundbreaking cases such as that of "Baby Doe," and present some rules of thumb for the pediatric cardiac surgeon and cardiologist to use when caring for children with congenital syndromes.