* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Present and Future trends in Paediatric Cardiology Dr Oliver
Survey
Document related concepts
Remote ischemic conditioning wikipedia , lookup
Heart failure wikipedia , lookup
Electrocardiography wikipedia , lookup
Management of acute coronary syndrome wikipedia , lookup
Cardiac contractility modulation wikipedia , lookup
Coronary artery disease wikipedia , lookup
Cardiothoracic surgery wikipedia , lookup
Hypertrophic cardiomyopathy wikipedia , lookup
History of invasive and interventional cardiology wikipedia , lookup
Myocardial infarction wikipedia , lookup
Cardiac arrest wikipedia , lookup
Arrhythmogenic right ventricular dysplasia wikipedia , lookup
Quantium Medical Cardiac Output wikipedia , lookup
Dextro-Transposition of the great arteries wikipedia , lookup
Transcript
Present and Future trends in Paediatric Cardiology Dr Oliver Stumper , MD,PhD Birmingham Children’s Hospital Birmingham, UK Paediatric Cardiology has developed dramatically over the past 50 years in the diagnosis and understanding of congenitally malformed hearts and their treatment. The past two decades have seen emerging treatment opportunities for the entire range of congenital heart disease. The major emphasis at present is to define the best investigative and therapeutic management approaches to these lesions in order to achieve best possible long-term outcome at the lowest morbidity and mortality. The diagnosis of congenital heart disease is shifting towards the antenatal period with routine screening programs being implemented before 20 weeks gestation. Detection rates still vary considerably throughout the UK and Europe. However, in the context of readily available postnatal (surgical) management with very low mortality rates and generally good outcomes there has not been a decline in the incidence of complex congenital heart disease requiring treatment. Certain lesions would ultimately benefit from fetal catheter or surgical interventions, but, at present, this approach remains experimental. Imaging the diseased heart by cardiac ultrasound has scaled new heights with the introduction of 3 and 4 dimensional imaging and functional assessment of myocardial performance. Cardiac MRI and CT scanning has become common-place offering detailed information and increasingly low radiation exposure. These trends in imaging have made cardiac catheterisation an almost exclusive interventional tool. Cardiac catheter interventional techniques have secured a firm and growing place in the treatment of so called simple lesions such as patent ductus arteriosus, atrial and ventricular septal defects, and pulmonary or aortic valve stenosis. But, increasingly, catheter techniques are being used and developed to replace initial palliative cardiac surgical intervention such as systemic-to-pulmonary artery shunts (stenting the right ventricular outflow tract or stenting the ductus arteriosus), or Norwood stage I procedure for hypoplastic left heart syndrome (hybrid stage 1 procedure). The treatment of adult coarctation or severe aortic stenosis in the elderly is about to become completely catheter based. Right ventricle to pulmonary artery conduit replacement will become a catheter rather than a surgical intervention. Transcatheter Fontan completion is further area which will become reality within the next 5 years or so. There will be further development of interventional techniques and materials, the most significant one being the development of custom-shaped biodegradable devices which will take account of the specific needs of a growing child into adulthood. These trends in the treatment of even complex congenital cardiac lesions, demand greater cooperation and integration of paediatric cardiology, surgical and anaesthetic teams to establish the facilities and clinical protocols that allow for this to happen. It is likely that all paediatric cardiac catheterisation theatres will be kitted out to also accommodate cardiac surgical intervention and an increasing number of cardiac surgical theatres will incorporate a angio system to aid in certain steps of combined interventions. The last decade has also seen an explosion of knowledge and understanding of the genetic basics of cardiovascular development and adaptation and the experimental use of stem cell therapy. These developments will, in time, lead to the development of targeted drug or cell therapy, possibly aided by specific interventional catheter techniques. Due to the ongoing shortage of donor hearts for paediatric cardiac transplantation there will be a dramatic improvement and pick-up of medium to long-term vascular and cardiac support devices, with percutaneously implanted impeller pumps being the most promising approach. At the same time, paediatric cardiologists and all other professionals involved in the care of patients with congenital heart disease will have to realize that the major part of their patient population has by now grown up. The biggest challenge for the next three decades will be to provide specialist care for the large number of adult patients with palliated congenital heart disease or those with significant haemodynamic lesions.