Pediatric cardiac surgery.

The surgical literature continues to report numerous successful series of neonatal correction for a variety of complex cardiac defects. Infant repair of defects, such as those of the atrioventricular canal, tetralogy of Fallot (with or without pulmonary atresia), truncus arteriosus, and transposition of the great arteries, is now considered routine, and in most instances, the results of infant correction surpass those of staged procedures. The use of palliative bands and shunts is consequently receiving less attention in the literature, although the selection of these procedures remains an important option for certain uncorrectable defects. The success of Norwood's operation for hypoplastic left-heart syndrome has encouraged application of major staging procedures as an appropriate therapeutic modality for certain complex defects as a stage towards eventual performance of the Fontan procedure. The Fontan procedure itself seems to show improved results with caval-pulmonary anastomoses, and the use of a bidirectional Glenn shunt or a hemi-Fontan procedure as a stage towards total Fontan physiology is gaining increased popularity. Aortic and pulmonary homografts have changed the technical options for patients with aortic valve disease as well as for infants with truncus arteriosus and tetralogy of Fallot with pulmonary atresia. Although surgeons continue to focus on optimal methods of neonatal myocardial protection, more attention is being given to perfusion techniques that protect the brain and organism as a whole. The use of intraoperative echocardiography has enhanced the standard of evaluation of operative repair so that fewer patients now leave the operating room with poor outcome. The outlook for patients born with congenital heart defects in 1992 continues to improve with enhanced applications of technology and operative technique.