Malčić Ivan, Anić Darko
Department of Paediatric Cardiology, University Hospital Centre Zagreb, Zagreb, Croatia.
Department of Cardiac Surgery, University Hospital Centre Zagreb, Zagreb, Croatia.
Front Cardiovasc Med. 2022 Feb 24;9:793166. doi: 10.3389/fcvm.2022.793166. eCollection 2022.
This article describes the establishment of a pediatric cardiac service program in a limited resource country. According to national epidemiological studies about 330 children with congenital heart disease (CHD) are born every year in Croatia. As a part of the former Yugoslavia, there was not an organized strategy for the pediatric cardiac service. After Croatian independence in 1991, even during the war, a need for such service led to the first step in the development of organized care for patients with CHD, a humanitarian mission provided by a non-governmental organization (NGO), from the United States. In the ten-year period (1993-2003), 601 children were operated on during this program. After the end of this program, the Croatian team was not able to cover the whole spectrum of pediatric cardiac care independently. About 60% of the children were sent abroad, and only about 40% of the operations were performed in Croatia. Over the time, the surgical team improved and after a specialized congenital heart surgeon joined, the number and quality of the program in the country raised, and the number of referrals to foreign centers gradually declined. In the meantime, a cardiological interventional program also improved. Today majority of standard congenital heart surgery procedures can be performed in Croatia. Last year our congenital heart team operated on 180 patients with low mortality and the interventional team (pediatric and adult) performed 66 procedures. In the article, we present positive shifts achieved during time as well as weaknesses and reasons for problems in establishing a high-quality CHD center.
本文描述了在一个资源有限的国家建立儿科心脏服务项目的情况。根据全国流行病学研究，克罗地亚每年约有330名先天性心脏病（CHD）患儿出生。作为前南斯拉夫的一部分，当时没有针对儿科心脏服务的有组织战略。1991年克罗地亚独立后，即使在战争期间，对这种服务的需求促使了为CHD患者开展有组织护理的第一步，这是一个来自美国的非政府组织（NGO）提供的人道主义任务。在十年期间（1993 - 2003年），该项目中有601名儿童接受了手术。该项目结束后，克罗地亚团队无法独立涵盖儿科心脏护理的全领域。约60%的儿童被送往国外，只有约40%的手术在克罗地亚进行。随着时间的推移，手术团队得到了改善，在一名专业先天性心脏外科医生加入后，该国项目的数量和质量有所提高，转往国外中心的病例数量逐渐减少。与此同时，心脏介入项目也得到了改善。如今，大多数标准的先天性心脏手术在克罗地亚都可以进行。去年，我们的先天性心脏团队为180名患者实施了手术，死亡率较低，介入团队（儿科和成人）实施了66例手术。在本文中，我们展示了随着时间推移所取得的积极转变以及在建立高质量CHD中心过程中存在的弱点和问题原因。
