Palliative procedures for congenital heart defects. 2009

Shi-Min Yuan, and Hua Jing
Department of Cardiothoracic Surgery, Jinling Hospital, School of Clinical Medicine, Nanjing University, Nanjing, Jiangsu Province 210002, People's Republic of China.

Although total repair of some congenital heart defects is possible in young children, palliative procedures still play an important role in relieving patients' symptoms, particularly in emergent settings, when total correction or surgical repair is not available. However, the concepts and taxonomies of the palliative procedures for congenital heart diseases sometimes seem to be ambiguous and confusing for young cardiac surgeons and cardiologists. This article gives a full-scope overview of the concepts, categories, indications, historical developments and clinical outcomes of the palliative procedures for congenital heart defects that have been documented in the literature. In total, there are 21 palliative procedures for the surgical management of congenital heart defects, which can be classified into four categories: firstly, increasing pulmonary artery flow for pulmonary oligaemia (including shunt procedures); secondly, decreasing pulmonary artery flow for pulmonary overcirculation (pulmonary banding and Norwood procedure); thirdly, enhancing intracardiac blood-oxygen mixture for systemic hypoxaemia (atrial septostomy subjected to different techniques); and, finally, other procedures, including congenital mitral or aortic stenosis palliation, coarctation of aorta palliation and hybrid palliative procedures for hypoplastic left heart syndrome. Modified Blalock-Taussig's and Glenn's shunts and pulmonary artery banding represent the pre-eminent palliative procedures for congenital heart defects and have been proven to be satisfactory after long-term clinical application. It seems that there is a growing trend towards the use of interventional techniques with stent deployment as an alternative to the surgical approach.

UI MeSH Term Description Entries
D010166 Palliative Care Care alleviating symptoms without curing the underlying disease. (Stedman, 25th ed) Palliative Treatment,Palliative Supportive Care,Palliative Surgery,Palliative Therapy,Surgery, Palliative,Therapy, Palliative,Care, Palliative,Palliative Treatments,Supportive Care, Palliative,Treatment, Palliative,Treatments, Palliative
D006328 Cardiac Catheterization Procedures in which placement of CARDIAC CATHETERS is performed for therapeutic or diagnostic procedures. Catheterization, Cardiac,Catheterization, Heart,Heart Catheterization,Cardiac Catheterizations,Catheterizations, Cardiac,Catheterizations, Heart,Heart Catheterizations
D006330 Heart Defects, Congenital Developmental abnormalities involving structures of the heart. These defects are present at birth but may be discovered later in life. Congenital Heart Disease,Heart Abnormalities,Abnormality, Heart,Congenital Heart Defect,Congenital Heart Defects,Defects, Congenital Heart,Heart Defect, Congenital,Heart, Malformation Of,Congenital Heart Diseases,Defect, Congenital Heart,Disease, Congenital Heart,Heart Abnormality,Heart Disease, Congenital,Malformation Of Heart,Malformation Of Hearts
D006348 Cardiac Surgical Procedures Surgery performed on the heart. Cardiac Surgical Procedure,Heart Surgical Procedure,Heart Surgical Procedures,Procedure, Cardiac Surgical,Procedure, Heart Surgical,Procedures, Cardiac Surgical,Procedures, Heart Surgical,Surgical Procedure, Cardiac,Surgical Procedure, Heart,Surgical Procedures, Cardiac,Surgical Procedures, Heart
D006439 Hemodynamics The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM. Hemodynamic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D015607 Stents Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting. Stent
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes

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