Iyer Parvathi U, Moreno Guillermo E, Fernando Caneo Luiz, Faiz Tahira, Shekerdemian Lara S, Iyer Krishna S
1Paediatric Intensive Care Unit,Fortis Escorts Heart Institute,New Delhi,India.
2Cardiac Intensive Care Unit,Hospital of Pediatría "Dr. Juan P. Garrahan",Buenos Aires,Argentina.
Cardiol Young. 2017 Dec;27(S6):S31-S39. doi: 10.1017/S1047951117002591.
In many parts of the world, mostly low- and middle-income countries, timely diagnosis and repair of congenital heart diseases (CHDs) is not feasible for a variety of reasons. In these regions, economic growth has enabled the development of cardiac units that manage patients with CHD presenting later than would be ideal, often after the window for early stabilisation - transposition of the great arteries, coarctation of the aorta - or for lower-risk surgery in infancy - left-to-right shunts or cyanotic conditions. As a result, patients may have suffered organ dysfunction, manifest signs of pulmonary vascular disease, or the sequelae of profound cyanosis and polycythaemia. Late presentation poses unique clinical and ethical challenges in decision making regarding operability or surgical candidacy, surgical strategy, and perioperative intensive care management.
在世界上许多地区，主要是低收入和中等收入国家，由于各种原因，及时诊断和修复先天性心脏病（CHD）是不可行的。在这些地区，经济增长促使心脏科单位得以发展，这些单位负责治疗先天性心脏病患者，这些患者的就诊时间往往晚于理想时间，通常是在早期稳定治疗的窗口期之后——大动脉转位、主动脉缩窄——或是在婴儿期进行低风险手术的窗口期之后——左向右分流或青紫型心脏病。结果，患者可能已经出现器官功能障碍、肺血管疾病的明显体征，或严重青紫和红细胞增多症的后遗症。就诊延迟在手术可行性或手术候选资格、手术策略以及围手术期重症监护管理等决策方面带来了独特的临床和伦理挑战。
