Park IS
Asian
Medical Center, Univ. of Ulsan College of Medicine, Seoul, Korea
Approximately 70-80% of patients (pt)
with CHD can now survive without sequela as a result of remarkable progress in
treatment (Tx) of CHD. Catheter Tx is well established as an initial or
supplementary Tx in various CHD. Now babies born with
pulmonary atresia with intact ventricular septum, complete TGA and single
ventricle (SV) have a better chance to survive with less sequela
and fewer operations due to a combined and planned approach from
echocardiographer, catheter interventionist and surgeon. Despite these
progress, however,
as much as 20-30% of pt either die or suffer from sequela even with state-of-the-art
Tx. Unsettled problems include Eisenmenger reaction, complex tetralogy of
Fallot with major aorto-pulmonary collaterals, truncus arteriosus, artificial
valve, heterotaxy, pulmonary vein stenosis, elastin arteriopathy, congenitally
corrected TGA, SV, and Fontan sequela. To improve outcome, we
need to change health care delivery system by developing standards for
practice, national or regional data registry with outcome disclosure, and centralizing
the care, as well as improving technical aspect in Tx. Finally, educating
primary care physicians and trainees to facilitate case recognition at an
earlier age is probably one of the most important endeavor to improve final
outcome for these children.