Symposium Looks at Options for Common Congenital Problems

Andrew C. Fiore, MD

Some of the most common congenital cardiac conditions do not have a single specific treatment of choice. During the Parallel Surgical Symposium: Congenital, from 1:15 p.m. to 4:30 p.m. Sunday in Room 126ABC, speakers will discuss alternative surgical techniques for treating neonates, infants, children, and young adults with commonly encountered congenital cardiac conditions.

The talks will focus on three atrioventricular septal defect (AVSD) repair options, the closed versus open arterial switch technique, three repairs for tetralogy of Fallot, management of hypoplastic left heart syndrome, medical or surgical treatment of the borderline ventricular septal defect (VSD), and valve repair or replacement for aortic valve disease.

“These are common problems that congenital heart surgeons deal with on a regular basis,” said co-moderator Andrew C. Fiore, MD, adding that he hopes the program will appeal to surgeons at all stages of their careers.

The two-part program will kick off with video-based presentations for AVSD treatment, the switch technique for transposition of the great arteries, and treatment of tetralogy of Fallot.

“These well-respected surgeons are experienced at doing their chosen operation. Each technique is effective, but there are pros and cons to each one,” said Dr. Fiore, Professor of Surgery at St. Louis University.

The second part of the symposium will examine whether new data should spur surgeons to change the way they manage common congenital cardiac pathologies. For example, most surgeons initially perform reconstructive operations for patients with hypoplastic left heart syndrome, but some surgeons believe these patients initially should undergo transplantation.

“We tend to favor reconstructive techniques as the first operation, but there may be a role for transplantation in the treatment of certain high-risk patient subgroups at various stages of their palliation for hypoplastic left heart syndrome,”said Dr. Fiore, adding that attendees will hear data on the pros and cons of reconstruction versus transplantation.

Next up, a cardiologist and a cardiothoracic surgeon will look at indications for closure of the restrictive VSD. Controversy surrounds the low but potential risk associated with surgical VSD closure versus the potential complications of continued observations, such as aortic valve incompetence, endocarditis at the VSD site, and the potential difficulty of obtaining health insurance in adulthood.

The third area, aortic valve disease, brings its own controversy with respect to valve repair or replacement. “Aortic valve repair is technically more challenging, but has become more refined, more popular, and with acceptable early durability,” Dr. Fiore said. “On the other hand, mechanical aortic valve replacement adds the important burden of lifelong anticoagulation, but greater long-term structural integrity.”

The Ross procedure, usually recommended for the growing child, avoids anticoagulation, but late complications of autograft dilatation, aortic insufficiency, and pulmonary homograft structural failure can emerge with now two valves, aortic and pulmonary, placed at continued lifelong risk.

“While we will not completely resolve these complex controversial issues, we hope that with an open exchange of new ideas and knowledge between surgeons and cardiologists at all levels of experience, we can better serve the neonates, infants, children, and adults with congenital heart disease that we are so privileged to care for every day,” Dr. Fiore said.