Congenital Heart Disease

Congenital Heart DiseaseCongenital Heart Disease

At Birth : 6~10 / 1,000 live birthAt Birth : 6~10 / 1,000 live birth

Natural Survivor at puberty (Presurgical era) : 5 ~ 15 %

Natural & Unnatural Adult Survivor (Surgical era) : over 85 %

‘‘Congenital Heart Disease’Congenital Heart Disease’ Korean experience during Korean experience during

past 50 Years past 50 Years

Heung Jae LeeHeung Jae LeeProfessor of Pediatrics, Sungkyunkwan University School of

Medicine Samsung Medical Center, Seoul,

Korea

Surgical Landmarks in Korea

1953, Pulmonary stenosis

1957, TOF shunt

1958, PDA ligation

1959, Open heart surgery (VSD) 1978, Fontan op

1985, Arterial switch op for TGA

Balloon valvuloplasy for Valvar PS

Open Heart Surgery in Korea

August 6th 1959

OHS for 8yr-old girl with VSD under cardiopulmonary bypass !!

YK Lee, CY Hong et al

First trial in Korea First trial in Korea

Cardiac Surgery for CHD in Korea

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'55 '59 '61 '63 '65 '67 '69 '71 '73 '75 '77 '79 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03 [Year]

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GNP [US $]

r Korean War

First Open Heart

Surgery

National Social

Security System

The Korean

Heart Foundation

The overseacharity

operation

Mrs. Hodges save over 3,300 Korean kids with CHD in 1970th

Early & mid 1970th in Korea

Early 1980th in Korea

Mrs. Lee Soon Ja Support Over 20,000 Kids during last 25 years

‘KHF-Pediatric Heart Fellowship’ program

Congenital Heart in Korea ....

Where are we now ??Where are we now ??

Congenital Heart Op (SMC 2001)

n = n = 428428

Intervention Vs OP in PDA

(Excluding NICU cases)

Percentile Profile of Current Management of CHD in Korea : 1992-2000

Cardiac surgery without Catheterization

VSD ASD TOF Neonatal PDA CoA/ IAA TAPVR, Truncus Arteriosus Critical AS in newborn Shunt op. in newborn Congenital Valvular Heart Ds (MR etc) TGA with IVS

Catheterization requiredCatheterization required when complete segmentalwhen complete segmental

analysis is not possibleanalysis is not possible..

Impact of fetal diagnosis ofcongenital heart disease

in Korea

Outcome of fetal Diagnosis(2000~2001)

Diagnosis TOP* FDIU** Op Neonatal death

VSD (n=54) 17 (31.4%) 1 4 1

TOF (n=40) 21 (52.5%) 2

Malpositions (n=25) 12 (48.0%)

PS (n=24) 1 (7 .1 %) 1

DORV (n=20) 11 (55.0%) 2

PA/IVS (n=16) 5 (31.2%) 1 7 1

HLHS (n=15) 11 (73.3%) 1 2 2

C-AVSD (n=13) 7 (53.8%) 1

D-TGA (n=8) 3 (37.5%) 0 5

COA (n=8) 3 (37.5%) 0 1

TOP*: termination of Pregnancy FDIU ** : Fetal death Intra Uterine

‘ Fetal Echo Effect’ in Korea Rate of termination of pregnancy (TOP)

33.2% in ’98-’99 period, 35.8% in ’00-’01 period

Associated with early diagnosis and associated extracardiac malformations including chromosomal anomaly

Perinatal mortality & morbidity of the CHDs which requires neonatal cardiac procedure is improving through the planned delivery at the cardiac center - 100% survival of arterial switch operation in cases with TGA with IVS in ’98-’99 period( 5 cases ) - The improved result of neonatal balloon angioplasty in cases with critical PS and PA IVS

We are now We are now in the Era of……in the Era of……

Neonatal/Infant Cardiac Surgery Dx. Era of Echocardiography & MRI Catheter Intervention Fetal & Perinatal Cardiology Grown Up Congenital Heart (GUCH) Molecular-genetic Approach, CATCH 22 etc.

Cardiac Surgery for CHD in Korea

0

1000

2000

3000

4000

5000

6000

'55 '59 '61 '63 '65 '67 '69 '71 '73 '75 '77 '79 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03 [Year]

1000

2000

3000

4000

5000

10000

100$ * *

1000$

2000$

5000$

10000$

0

GNP [US $]

r Korean War

First Open Heart

Surgery

National Social

Security System

The Korean

Heart Foundation

The overseacharity

operation

Two major factors for the success

Heart to Heart Project; With Vietnamese Kids & Doctors at SMC

1) Rapid economic development & Active social supporting systems

(such as social security system and philanthropic organizations)

2) Overseas training for medical experts and their commitment.