SHA24/042002

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