Not all congenital heart disease requires treatment. Some mild congenital heart defects repair themselves. For example, in cases of small ventricular septal defect, the “hole in the heart” often becomes smaller, eventually closing by itself, as the child grows. However, the majority of congenital heart conditions do need treatment, and this varies depending on the type and complexity of the congenital defect.
The treatment of congenital heart disease has developed dramatically over the past 40 years. This can be illustrated using a condition called transposition of the great arteries as an example. In transposition of the great arteries, the two main arteries of the heart, the aorta and the pulmonary artery, are transposed, or switched, so that de-oxygenated rather than oxygenated blood is pumped around the body. Without treatment 90% of babies born with this condition die within 12 months.
In the early 1960’s treatment for transposition of the great arteries was revolutionised by the first ever interventional catheterisation technique, the balloon septostomy. This was superseded later that decade by an operation known as the Mustard or Senning. This had excellent results (less than 5% mortality in childhood) and continued to be performed until the 1980’s. However, it became clear after long-term follow up, that while the Mustard/Senning operation gave babies with transposed great arteries a much better prognosis during childhood, morbidity and mortality in early adulthood were high. A new operation, the arterial switch, which gave an “anatomical repair”, was introduced in the early 1990’s. This had much lower success rates to begin with, but was developed in the expectation of better late results compared to the Mustard/Senning treatment. This proved to be the case together with marked improvement in surgical survival. The arterial switch is now the standard treatment for babies born with transposition of the great arteries.
This rapid evolution in the treatment of congenital heart disease, together with considerable variation in practice at the UK’s specialized centres for paediatric and GUCH patients, means the availability of simple nationally representative data on the treatment of congenital heart disease is limited.
