Congenital cardiovascular disease and cardiac surgery in childhood: Part 2. Acyanotic congenital heart defects and interventional techniques.

The literature for the period reviewed documents a significant reduction of morbidity and mortality for neonatal repairs of atrioventricular septal defects, coarctation of the aorta, and ventricular septal defects. Long-term follow-up of patients with coarctation of the aorta provides important suggesting that earlier repair of asymptomatic coarctation and complete elimination of obstruction in the arch as well as at the coarctation site are essential to better long-term results. Surgery for complete atrioventricular septal defect has evolved from palliation, with poor long-term results, to complete repair within the first 6 months of life, with minimal morbidity and mortality. Special emphasis is now placed on children with Down's syndrome who have complete atrioventricular septal defects; data confirm their tendency for earlier development of pulmonary vascular obstructive changes. Further refinements in surgical and interventional catheterization techniques have resulted in promising advances for many lesions--coarctation of the aorta (native and recurrent); valvular, subvalvular, and supravalvular aortic stenosis; valvular pulmonary stenosis; patent ductus arteriosus; and branch pulmonary artery stenosis--and have prompted provocative discourse between cardiologists and surgeons. These refinements in surgical and interventional techniques have initiated a new era in the clinical management of congenital heart disease in childhood.