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J Thorac Cardiovasc Surg 2008;135:240-242
© 2008 The American Association for Thoracic Surgery

Editorial

Improving neurologic and quality-of-life outcomes in children with congenital heart disease: Past, present, and future

Cardiac Intensive Care Unit, The Cardiac Center at The Children’s Hospital of Philadelphia, and the University of Pennsylvania School of Medicine, Philadelphia, Pa.

Received for publication April 6, 2007; revisions received June 26, 2007; accepted for publication July 5, 2007.

^_* Address for reprints: Gil Wernovsky, MD, Pediatric Cardiology, 34th St and Civic Center Blvd, Philadelphia PA, 19104. (Email: Wernovsky@email.chop.edu).

The first 20% of the full text of this article appears below.

They say that time changes things, but you actually have to change them yourself (Andy Warhol).

Prostaglandin and Echocardiography

That’s what started this whole journey. Before the end of the 1970s, most neonates with critical congenital heart disease (CHD) did not survive if their pulmonary or systemic blood flow was dependent on a patent ductus arteriosus. Even in the rare neonate who was lucky enough to have spontaneous patency of the ductus, making a complete diagnosis to plan cardiac surgery required catheterization; 30 years ago cardiac catheterization was associated with significant morbidity, especially in a fragile neonate. It’s no wonder surgical mortality was so high in those days. Even though the technical aspects of cardiac surgery could be applied to small babies, the status of the infant entering the operating room was tenuous, and the infant not infrequently had an incomplete diagnosis.

Enter bedside noninvasive diagnostic capabilities and the availability of medical support to stabilize the infant. Mechanical ventilation was being applied to smaller and smaller infants, hemodynamic monitoring was improving, and the new subspecialty of cardiac intensive care allowed for increasingly stable babies to survive palliative and reparative procedures. Improvements in surgical technique and cardiopulmonary bypass followed soon thereafter. Intraoperative echocardiography increased the likelihood of leaving the operating room with a better understanding of the physiology of the neonate and status of the repair.

For those of us in the practice of pediatric cardiology, this was an exciting time indeed. Survival, even for infants with the most complex lesions, was now expected. Cardiologists and intensivists painted a very different prognosis for families than we had even 10 years earlier. However, with these successes came new realizations. As we began to observe these outpatients in larger . . . [Full Text of this Article]

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