NEW TRENDS IN THE MANAGEMENT OF CONGENITAL HEART-DISEASE

Considerable improvements have been made in the diagnosis and treatmen t of congenital heart disease during the last decade. Many congenital heart lesions are now treated successfully during the neonatal period that previously were associated with high mortality. Improved echocard iographic imaging, catheterization techniques, and earlier surgical re pair are factors that have resulted in greater success in the treatmen t of congenital cardiac disease. Diagnosis has been improved greatly w ith advancements in echocardiography and angiography. Better ultrasoun d technology combined with doppler techniques and transesophageal echo cardiography allow more accurate preoperative assessment and therefore more successful surgical repair. Cardiac catheterization techniques h ave also improved and, when combined with treatment such as balloon an gioplasty, have changed the treatment of certain cardiac anomalies suc h as pulmonary stenosis or coarctation of the aorta. Operative treatme nt of congenital heart disease has improved the short- and long-term s urvival of most infants with congenital cardiac anomalies. Improved ca rdiopulmonary bypass techniques, better suture material, and the abili ty to perform cardiac transplantation are examples of technology that allows earlier, more complete repair of these complex cardiac defects. Reviewed here are improvements in the treatment of four complex cardi ac anomalies that occur in newborns and are associated with high morta lity when left untreated. All four anomalies have undergone significan t changes in the approach to their treatment with dramatic improvement s in survival.