Abstract
Since the description of surgery for patent ductus arteriosus in late 1930s, an innumerable number of advances have taken place in the management of congenital heart defects (CHDs). In this review the current status of treatment of seven of the most common acyanotic CHDs was reviewed. The discussion included indications for, and timing of, intervention and methods of intervention. The indications are, by and large, determined by the severity of the lesion. Pressure gradients in obstructive lesions and the magnitude of the shunt in left-to-right shunt lesions are used to assess the severity of the lesion. The timing of intervention is different for each lesion and largely dependent upon when the criteria for indications for intervention were met. Appropriate medical management is necessary in most patients. Trans-catheter methods are preferable in some defects while surgery is a better option in some other defects. The currently available medical, trans-catheter, and surgical methods to treat acyanotic CHD are feasible, safe, and effective.
Highlights
Since the description of ductal ligation by Gross and Hubbard [1] in the late 1930s, utilizing digoxin to treat children with congenital heart defects (CHDs) by Gibson [2] and Taussig [3] in mid-1940s, and trans-catheter treatment of tricuspid and pulmonary valve stenosis by Rubio and Limon-Lason [4,5]in the early 1950s, remarkable advances in the management of CHD have occurred
Some cardiologists advocate balloon valvuloplasty for lesser gradients, but the author believes that the indications for intervention should remain the same as for surgical intervention and the reasons for such recommendation were detailed in a prior review for the interested reader [19]
Since balloon pulmonary valvuloplasty is successful in most cases (Figure 2) [22,27], surgical management is reserved for cases with supravalvular pulmonary artery stenosis, severe valve annular hypoplasia, and dysplastic pulmonary valves
Summary
Since the description of ductal ligation by Gross and Hubbard [1] in the late 1930s, utilizing digoxin to treat children with congenital heart defects (CHDs) by Gibson [2] and Taussig [3] in mid-1940s, and trans-catheter treatment of tricuspid and pulmonary valve stenosis by Rubio and Limon-Lason [4,5]. The author has, from time to time, reviewed the diagnostic and management aspects of CHD [6,7,8,9,10,11,12,13,14,15,16]. The author reviews the current state of the art management aspects of the most common CHD. CHD, a brief description of the defect will be included followed by indications for intervention, timing of intervention, and type of intervention. Due to the extensive nature of the material, discussion of acyanotic CHD will be included in this paper and cyanotic CHD will be discussed in the paper
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