J.Jpn. Surg. Soc.. 109(4): 205-209, 2008

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Feature topic

RECENT PROGRESS IN SURGICAL TREATMENT OF CONGENITAL HEART DEFECTS

Since Jatene's, Norwood's and Fontan's eras, recent striking progress in surgical treatment for patients with congenital heart defects has been achieved based on several advances, including 1) selecting an appropriate staged strategy for each phase of growth and development immediately after birth, 2) early complete and definitive repair, and 3) noninvasive diagnoses and surgical treatment, all of which lead to good ventricular function and exercise tolerance later in life. General cardiopulmonary bypass and support techniques have been improved to prevent the systemic inflammatory response syndrome with capillary leakage. Washing blood primes, diluted ultrafiltration, and modified ultrafiltration are routinely performed. The arterial switch operation is one of the greatest achievements in neonatal cardiac surgery during the past three decades. The most crucial step in arterial switch is related to coronary mobilization and transfer without myocardial ischemia. The specific issue in the Norwood operation for hypoplastic left heart syndrome is the regulation of pulmonary blood flow. Right ventricle-pulmonary artery shunt in the Norwood operation provides stable systemic circulation and adequate pulmonary blood flow without delicate postoperative management to control pulmonary vascular resistance. Cerebral and lower systemic dual perfusion is very useful for arch repair in early infancy. Complete repair of tetralogy of Fallot around six months of age has shown satisfactory results.

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