Surgery Should be Offered to Certain Types of Congenital Heart Disease in Gulf Region: Con Jameel AlAta Consultant and associate professor pediatric cardiologist KAAUH/ KFSH&RC Jeddah SHA / GHA FEB 2013
Are we there to provide or deny?? ď‚— Health professionals are there to provide treatment ď‚— Denial of treatment is discouraged
What is a treatment? Has substantial benefit Not harmful Just and respects patient autonomy.
Define the goal of treatment Acute life saving with acceptable known short term outcome
or ambiguous Improving future cardiac condition and life of the patient Palliative or Curative
Implications of scarce resources What to do with equal access for equal illness Who makes the decision and based on what Quality of life / patient / society best of interest
HLHS ď‚— A relative CON as Norwood surgery mortality remains very
high in many centres ď‚— A relative CON as it is a palliation with high interim mortality before reaching the Glenn stage ď‚— A true CON if patient has contraindications like moderate
or more av-v regurge or depressed function
L-TGA ď‚— A true CON if no other surgical indication present
Natural history outcome is almost equal to Double switch operation
L-TGA VSD PS A relative CON if; No CHF No PHTN SPO2 > 84% Specially if ventricles were unbalanced How about volume load What about cyanosis.
Single ventricle with PS ď‚— AS long as SPO2 >84% and no added morbidities they
remain a relative CON for the Glenn and Fontan procedure ď‚— Ventricular volume unloading can improve exercise capacity
but at a very high long term expense
The Fontan palliation The palliation that needs correction A relative CON as the long term complication like PLE,
Thrombo-embolism are lethal A true CON if the Fontan criteria are not met
Helpful equations SB + NH + C = ABSOLUTE PRO SB + NH + P = RELATIVE PRO SB + NNH + C = RELATIVE PRO SB + H + C = RELATIVE CON SB + H + P = RELATIVE CON EB + NH + P= RELATIVE CON NB + NH + P= ABSOLUTE CON NB + H + C or P = ABSOLUTE CON
CONCLUSION THERE ARE NOT MANY CON FOR OPERATING ON
CHILDREN WITH HEART DISEASE TODAY BUT THE MERE ABILITY TO OPERATE IS NOT AN ABSOLUTE PRO TO DO SO
THANK YOU