Rossano Joseph W, Kaufman Beth D, Rame J Eduardo
Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
World J Pediatr Congenit Heart Surg. 2013 Jan;4(1):70-4. doi: 10.1177/2150135112469040.
Heart failure frequently complicates congenital heart disease (CHD) in children and adults. In patients with end-stage disease, mechanical circulatory support may improve survival, quality of life, and serve as bridge to cardiac transplantation. There are many ethical issues surrounding the use of mechanical circulatory support in patients with CHD including the use of prospective and randomized trials, proper oversight of new therapies, and transparency in reporting. Additionally, there are ethical considerations relevant to the greater society as these therapies are highly resource intensive in a resource-limited society. This article will review the burden of disease of heart failure in patients with CHD, the challenges of mechanical circulatory support and heart transplantation, and the ethical considerations and problems that arise for this population.
心力衰竭常使儿童和成人的先天性心脏病（CHD）复杂化。在终末期疾病患者中，机械循环支持可提高生存率、改善生活质量，并作为心脏移植的桥梁。围绕CHD患者使用机械循环支持存在许多伦理问题，包括前瞻性和随机试验的使用、对新疗法的适当监督以及报告的透明度。此外，由于这些疗法在资源有限的社会中资源消耗极大，因此存在与更广泛社会相关的伦理考量。本文将综述CHD患者心力衰竭的疾病负担、机械循环支持和心脏移植的挑战，以及该人群出现的伦理考量和问题。
