Page 41 - ANZCP Gazette MAY 2014

THE CATHETER LAB AND
THE CHANGING FACE OF CARDIAC SURGERY Dr. Lucas J. Eastaugh
The Royal Children’s Hospital Melbourne, Department of Cardiology, Flemington Road, Parkville VICTORIA 3052
Background
The role of cardiac catheterisation in the management of patients with congenital heart disease has significantly changed since the first cardiac catheterisation procedure was performed in 1929. The modern paediatric interventional laboratory is required to manage patients with complex forms of structural heart disease from small newborn infants to large adults. Increasingly, more complicated and higher risk transcatheter procedures are being performed. With more complex procedures comes an increased reliance upon our surgical and perfusion colleagues to be aware of the types of invasive procedures being performed, the risks and possible complications, as well as an understanding of the issues related to working in a cardiac catheterisation laboratory. MRI and radiation safety, the ergonomics and setup of the catheterisation laboratory are but a few of the challenges facing modern-day cardiac surgeons and perfusionist’s.
Aims/Objectives
The aim of this review is to examine the evolving role of the
interventional cardiologist, cardiothoracic surgeon and cardiac perfusionist in the so-called “hybrid” approach to managing congenital heart disease.
Methods
A review current literature and of our departmental database was performed to identify the types of procedures and scenarios, which may require cardiothoracic surgical and bypass support.
Findings/Conclusions
Collaboration between cardiologist, surgeon and perfusionist requires careful co-ordination and understanding of the issues related to the types of procedures performed in the modern cardiac catheterisation laboratory. With the increasing complexity of procedures performed, this relationship will continue to evolve and require a greater understanding of the unique roles performed by each member of the team.
THE LOOMING PLAGUE OF
ADULT CONGENITAL HEART SURGERY PATIENTS
A/Pr Yves d’Udekem Royal Children’s Hospital, Melbourne
Today there are more adults with congenital heart disease (most of them operated) than children with an estimate of 30 000 in Australia. But we should not be deluded in believing that they are cured. Heart failure and sudden death are frequently encountered in this patient population.
The manifestations of heart failure are different in congenital patients. They tend to be asymptomatic, to be at higher risk of death once symptomatic, and to often suffer from arrhythmias.
Heart failure in congenital patients is mainly a disease of the right ventricle. Patients with right ventricle assuming the systemic circulation may fail and repaired tetralogy of Fallot may come at any stage with dilated right ventricular cavities.
There are today in Australia more than 1000 patients with a single ventricle who have survived the Fontan procedure, the last of a series of procedure. After the Fontan the systemic veins are connected directly to the pulmonary arteries, bypassing the heart. It has become clear that this population is undergoing a steady growth and will double within 15 years. The Australia and New Zealand Fontan Registry has now demonstrated that the majority of these patients may hope to survive 3 decades after Fontan surgery. But they are functioning close to their maximal reserve capacity and may fail abruptly. We know today that we will not have enough donor organs to transplant those who fail. What will we do to provide them with a fulfilling adult life?
MAY 2014 | www.anzcp.org
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