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Congenital Heart Disease. At 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’ Korean experience during past 50 Years. Heung Jae Lee. - PowerPoint PPT Presentation
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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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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.