THE INFANT WITH HEART DISEASE

Abstract

IN SPITE OF great surgical advances, congenital heart disease is still a major cause of death in children, and this is particularly true in the infant age group. The magnitude of the problem may be appreciated by viewing some data on mortality from congenital heart disease collected by Carlgren in Gotenberg, Sweden. He reviewed the history of all individuals born with congenital heart disease in a 10-year period in that city. Within 15 years after birth, 40% of these individuals had succumbed. The really important factor which emerged, however, is that 30% of these patients died in the first 6 months after birth. In reviewing the causes of death in this group, I have estimated that at least 50% of these infants died of lesions which can be cured or relieved by procedures presently available. It is thus obvious that it is incumbent on us, as pediatricians, to recognize and treat the child with heart disease at the earliest possible age. Recognition of heart disease, and particularly of specific congenital lesions, is considerably more difficult in the infant than in the older child. One problem is that the lesions encountered in infancy may be much more complicated than in older children, because after the first year many of the infants with complicated lesions may have already succumbed. More important though, is the fact that many congenital heart lesions do not present the classical clinical features we have come to recognize with specific lesions in the older child. For example, the presence of only a systolic murmur or even an absence of murmur may occur in an infant with patent ductus arteriosus, rather than the typical continuous machinery murmur seen in the older youngster.