[Date of surgery in congenital cardiopathies]

The appropriate time for surgical intervention in congenital cardiopathies is chosen as a function of several imperatives; psychological and family reasons militate in favour of an early intervention. In particular, in cardiopathies accompanied by pulmonary arterial hypertension (serious VSD, arterial transpositions with VSD, etc.) there is a risk of irreversible obstructive pulmonary arterial disease in the first months of life in some cases. This risk, added to those of cardiac insufficiency, prompts early intervention. The progressive risks of cyanotic cardiopathies: risks of intravascular thrombosis and of cerebral abscess have contributed to these cardiopathies being operated upon earlier than was done some years ago. The decision to be taken remains difficult for complex cardiopathies. Coarctations of the aorta are usually operated upon before the age of 4 years in order to avoid the risk of permanently fixed arterial hypertension and premature vascular degeneration. The operative indications in aortic stenoses are now guided not only by clinical data but also by an assessment of the haemodynamic tolerance by ultrasonography and exertion tests.