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Late results of surgery for congenital heart defects
B Friedli1, B Faidutti, I Oberhänsli
1Clinique de Pédiatrie, Hôpital cantonal universitaire, Genève.
Insights
Long-term results of congenital heart defect surgery show that while most patients thrive, some face hemodynamic issues, arrhythmias, or growth problems. Adult cardiology now faces the challenge of managing these complex cases.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Congenital heart defect (CHD) surgery has evolved over 50 years, with long-term data now available.
- While many CHD patients achieve normal lives post-surgery, persistent complications exist.
Purpose of the Study:
- To review the long-term outcomes and challenges following surgical repair of congenital heart defects.
- To highlight the evolving needs of adult patients with previously repaired CHDs.
Main Methods:
- Analysis of long-term results from both closed and open-heart surgical procedures for CHDs.
- Review of common complications including hemodynamic anomalies, ventricular dysfunction, and rhythm disturbances.
Main Results:
- Hemodynamic issues (residual lesions, hypertension) and ventricular dysfunction are noted.
- Rhythm disturbances (conduction defects, arrhythmias) increase over time, posing risks like sudden death.
- Growth issues arise with implanted foreign materials; many patients now transition to adult care.
Conclusions:
- Long-term surveillance is crucial for identifying and managing late complications after CHD surgery.
- The increasing adult CHD population presents unique challenges requiring collaboration between pediatric and adult cardiologists.
Abstract:
Surgery for congenital heart defects started 50 years ago with "closed" procedures, and open heart surgery is in its forth decade. Thus, long-term results are now available. Although a majority of patients lead normal lives, problems do exist. Hemodynamic anomalies can be related to residual lesions or to persistent systemic hypertension (after coarctation repair) or pulmonary hypertension (after late repair of left to right shunt lesions). Right or left ventricular dysfunction may be observed, due to longstanding overload, hypoxia or to the open heart procedure itself. Rhythm disturbances have a tendency to increase with the passage of time after surgery. After ventricular surgery (repair of ventricular septal defect and tetralogy of Fallot), conduction defects and ventricular arrhythmias are prevalent. They may lead to late sudden death. After atrial surgery, sinus node dysfunction and atrial arrhythmias are observed. Problems related to growth of the patient exist essentially in cases where foreign material (conduits, prostheses) have been implanted. Many patients, with definitive repair or palliative operation, have become adults. This is a new challenge for the adult cardiologist, and it is a duty of the pediatric cardiologist to hand over his knowledge of this pathology.