Current status of surgery for congenital heart disease in infancy

During the past 10-15 years, a better understanding of the anatomy and physiology of congenital heart disease, improved pre- and postoperative care, deep hypothermia and circulatory arrest, and miniaturization of equipment, among other factors, have contributed to the greatly increased safety of open-heart surgery in neonates and infants. Consequently a trend towards early correction has developed, which prompts the question: 'In which congenital heart anomalies presenting early in life should primary repair be preferred to initial palliation followed by late repair?' It is imperative to weigh the advantages and disadvantages of a two-stage 'palliative + corrective' procedure against primary correction. The latter is generally preferred for 'simpler' malformations such as ventricular septal defect, tetralogy of Fallot, simple transposition and atrioventricular canal malformation, where repair can be achieved with low risk. On the other hand, palliation by pulmonary artery banding, atrial septectomy or a systemic-pulmonary shunt is still preferable in those conditions in which total correction in infancy carries a high risk or is not feasible. In an underdeveloped population group the decision may be influenced by the prevalent socio-economic factors affecting the physical condition of the patient. Palliative procedures may constitute a very satisfactory method of selecting those patients in whom eventual complete correction would be justified.