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1. Congenital heart disease comprises a wide morphologic spectrum. In general, lesions can be conceptualized as those which can be completely repaired, those that should be palliated, and those that can be either repaired or palliated depending on particular patient and institutional characteristics.

2. Percutaneous therapies for congenital heart disease are quickly becoming important adjuncts, and in some cases, alternatives, to standard surgical therapy. Important examples include percutaneous closure of atrial and ventricular septal defects, the hybrid approach to hypoplastic left heart syndrome, radiofrequency perforation of the pulmonary valve, and percutaneous pulmonary valve placement. Further studies are necessary to establish criteria and current benchmarks for the safe integration of these novel approaches into the care of patients with congenital heart surgery.

3. Outcomes have improved substantially over time in congenital heart surgery, and most complex lesions can be operated in early infancy. Neurologic protection, however, remains a key issue in the care of neonates undergoing surgery with cardiopulmonary bypass and deep hypothermic circulatory arrest. New monitoring devices and perioperative strategies are currently under investigation. Attention in the field has shifted currently from analyses of perioperative mortality, which for most lesions is under 10%, to longer-term outcomes, including quality of life and neurologic function.

Congenital heart surgery is a constantly evolving field. The last 20 years have brought about rapid developments in the technologic realm as well as a more thorough understanding of both the anatomy and pathophysiology of congenital heart disease (CHD), leading to the improved care of patients with this challenging disease.1,2

These new advancements created a paradigm shift in the field of pediatric heart surgery. The traditional strategy of initial palliation followed by definitive correction at a later age, which had pervaded the thinking of most surgeons, began to evolve to one emphasizing early repair, even in the tiniest patients.2 Furthermore, some of the defects that were virtually uniformly fatal [such as hypoplastic left-heart syndrome (HLHS)] now can be successfully treated with aggressive forms of palliation using cardiopulmonary bypass (CPB), resulting in outstanding survival for many of these children.

Because the goal in most cases of CHD is now early repair, as opposed to subdividing lesions into cyanotic or noncyanotic lesions, a more appropriate classification scheme divides particular defects into three categories based on the feasibility of achieving this goal: (a) defects that have no reasonable palliation and for which repair is the only option; (b) defects for which repair is not possible and for which palliation is the only option; and (c) defects that can either be repaired or palliated in infancy.3 It bears mentioning that all defects in the second category are those in which the appropriate anatomic components either are not present, as in HLHS, or cannot be created from existing structures.

Atrial Septal Defect

An atrial septal defect (ASD) is defined as an opening ...

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