Malformations in adult cases in Egypt.

The pathologic patterns as an indication for cardiac surgery in adults with congenital heart diseases and subsequently the surgical techniques have changed greatly in the last decade. The presence of fully equipped pediatric cardiac units helped in early surgical repair in many lesions. However, this service is not always readily available in many parts of the world with the effect of seeing patients with congenital heart diseases latter on during their life needing intervention. Also, older surgical concepts (like considering a trileaflet mitral valve as normal) resulted in the presentation of a subgroup of patients who needed re-intervention latter during adulthood. Surgeons are also faced with the residual effects of putting in different kinds of prosthetic valves or homografts that degenerates or the child overgrows and need to be dealt with latter during the child life. Although the interventional transcatheter techniques helped in the closure of small atrial septal defects, patent ducti, pulmonary arteriovenous fistulas, and dilatation of coarctations, it helped in the emergence of a new pathologic entities like failed or complicated transcatheter closure or dilatations. As a result of competition with the cardiologists, minimal access cardiac surgery emerged. Upper and lower partial ministernotomies and right thoracotomy and fast-track congenital heart operation in some lesions had effectively decreased pain and discomfort, shortened the recovery period, and improved the cosmetic result.