Congenital heart disease in infancy--surgery for specific defects

The evolution of surgery for congenital cardiac malformations in infancy in the past decade warrants an analysis of the indications, technical aspects, advantages, complications and results of the treatment of specific defects. Considerable variations in approach are found, and every surgeon should attempt to evaluate the most appropriate current management in each particular case. Primary closure is usually preferred to pulmonary artery banding in patients with large ventricular septal defects. But will the same approach produce a high late survival rate in patients with other left-to-right shunts, e.g. atrioventricular canal and truncus arteriosus? Primary repair of tetralogy of Fallot, for example, especially in patients who might require a pulmonary outflow tract patch, has been challenged by many. In which patients, if any, is an initial systemic-pulmonary anastomosis the preferable treatment? Which is the best surgical approach for other cyanotic congenital cardiac malformations such as transposition of the great arteries and pulmonary and tricuspid atresia? The multitude of procedures available for 'complete correction' of some malformations is an indication of their limitations, while other defects, such as some forms of univentricular heart and hypoplastic left heart, are not yet fully correctable.