Operative cardiac surgery of congenital heart diseases
The history of open heart surgery in the current sense has run into 61 years. In 1952 the American surgeon F. John Lewis performed the first surgery on the stopped heart in a patient with congenital disease – atrial septal defect. In 1953 John H. Gibbon performed the same surgery using the heart-lung machine which gave start to the development of the cardiovascular surgery. One can only imagine how long the surgeons were preparing to such interventions if already in 1954 the operations for repair of ventricular septal defect, tetralogy of Fallot, heart valve replacement were introduced into clinical practice and so on. But the congenital heart defects have always remained the field of special responsibility, the allowance to such operations has been strictly regulated, results have been thoroughly analysed, the new specialists have been trained and so on. During the past years the cardiac surgery in general and congenital heart defects surgery in particular have changed radically. As is known if the congenital heart defect was not repaired in due time, 36 % of infants die within the first month of life (“critical” defects of the neonatal period), 35.5 % more – die within the first year. This event and considering the rapid development of technologies have allowed very swiftly to switch the attention of the doctors’ community and the public to the problem of neonates and to solve it to a certain extent. In present conditions the length of life of 97 % of infants who underwent surgery in due time is the same as for the healthy infants of their age. Experience accumulation in conditions when the cardiac surgery has become the compulsory assistance in the case of anatomical anomalies in the heart, have led to the fact that today in various countries the great number of people who earlier underwent cardiac surgery are living. In the part of them such interventions were palliative, the other part developed the natural problems with the heart due to the degenerative processes in prostheses leading for instance in the case of tetralogy of Fallot to valve insufficiency of the pulmonary artery and necessity to replace it. So the other large contingent of patients with congenital heart diseases who needed the further treatment are the patients who earlier underwent the surgery for heart defect. On account of many circumstances in all countries including our country there is a large contingent of people who not only survived the infancy and childhood but rather often live up to forty-fifty years and refer to the doctor because of the suddenly developed disease. The more often they are the patients with the atrial septal defect, with partial anomalous drainage of pulmonary veins, some other heart defects leading at a certain period of time to development of atrial fibrillation, dyspnea and understanding of the disease by a patient. Now the surgical methods of treatment of practically all congenital heart diseases have been worked out up to the optimum level. There are hand books and textbooks on operative surgery for congenital heart defects. Our deep conviction is that the thinking cardiac surgeon urgently needs the permanent information on existing methods of treatment even if they haven’t changed. Considering the above we decided to begin publication of the techniques of surgical treatment of congenital heart defects in the long existing and having rather large audience journal. In the present issue of the journal we suggest looking through the recent development of surgical treatment of atrial septal defect and anomalous drainage of pulmonary veins. We shall be grateful for remarks and wishes concerning the improvement of illustrations and content of the work. Academician L. A. Bockeria