How to correctly choose the timing of congenital heart disease treatment and treatment methods
1.Incomplete ductus arteriosus
Timing of treatment: Any arterial duct that does not close after 6 months of life needs to be followed up or treated surgically, and the most appropriate age for surgery is within 6 years.
Treatment modalities.
(1) Transthoracic minimally invasive arteriovenous occlusion: arteriovenous diameter <1cm;
(2) Interventional treatment: arterial duct diameter <1cm and weight >15kg;
(3) Surgical treatment: arterial duct diameter >1cm.
2.Atrial septal defect
Timing of treatment: the age of surgery is most ideal for preschool. However, patients with large defects and congestive heart failure in infancy should be operated early without age restriction; for adults, atrial defects smaller than 5 mm can be considered for follow-up observation, and if there are no hemodynamic changes, surgery can not be performed; however, such unoperated patients have the risk of increasing the incidence of endocarditis.
Treatment modalities.
(1) Transthoracic minimally invasive atrial septal defect closure: central-type atrial defects <2 cm in diameter can be treated with intervention, and postoperative anticoagulation therapy is required for 6 months;
(2) Interventional treatment: central atrial defect <2 cm in diameter can be treated with interventional treatment, and anticoagulation therapy is required for 6 months after surgery;
(3) Surgical treatment: superior and inferior atrial defect can only be treated by open-heart surgery; atrial defect >2.5cm can only be treated by open-heart surgery, and postoperative anticoagulation therapy is not required.
3.Ventricular septal defect
Treatment timing.
(1) Light children (ventricular defect <5mm), infancy and early childhood is not urgent surgery, before school age (6 years) is still not closed, surgery can be considered;
(2) moderate ventricular defects (5-9 mm), requiring surgery at the age of 3-5 years;
(3) Patients with non-restricted ventricular defect (>10mm), sub-stem ventricular septal defect, multiple ventricular septal defects, combined heart failure, combined moderate or higher pulmonary hypertension, combined valve closure insufficiency, should be operated as early as possible regardless of their age to avoid losing the opportunity for surgery.
Treatment modalities.
(1) Transthoracic minimally invasive ventricular septal defect closure: ventricular defect diameter <1cm can be considered for closure, and anticoagulation therapy is required for 6 months after surgery;
(2) Interventional treatment: only perimembranous ventricular defect <1cm in diameter can be considered for closure, but there is a possibility of complications such as aortic valve injury, conduction bundle injury and tricuspid valve injury in the near and distant future, and anticoagulation therapy is required for 6 months after surgery;
(3) Surgical treatment: open-heart surgery is available for any fractional ventricular defect, and the current guidelines for the treatment of congenital heart disease in Europe and the United States recommend open-heart surgery as the preferred method for treating ventricular septal defects.
4.Farrow’s tetralogy
Timing of treatment: There is no age limit, and satisfactory results can be obtained from newborns to adults. In principle, surgery is performed before disuse atrophy of the left ventricle and pulmonary artery occurs.
Treatment modalities.
(1) Radical surgery: excision of the hypertrophic muscle bundle of the funnel and unblocking of the right ventricular outflow tract; repair of the ventricular septal defect with a patch; widening and shaping of the right ventricular outflow tract and pulmonary artery with a patch;
(2) Palliative surgery (bypass surgery): when the pulmonary artery is poorly developed, palliative surgery is performed first, followed by observation of pulmonary vascular development, and radical surgery is performed when its development improves.