Annex A > Chapter 3 - Developments in the UK, in the Diagnosis and Treatment of Congenital Heart Abnormalities in Children, 1984-1995 > Introduction
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Introduction
1 This is a concise account of the history of the development of diagnosis and treatment of congenital heart disease [1] in children in the United Kingdom, with special reference to the period 1984 to 1995. It is written for the lay person. [2] It presents:
- a concise history of the development of cardiac surgical services for children with congenital heart disease in the United Kingdom, with special reference to the period 1984 to 1995;
- a description of methods of diagnosis and strategies of management in general terms;
- the differences between the normal heart and hearts with congenital abnormalities;
- a discussion of specific heart abnormalities in terms of the problems that they present, the symptoms they cause, the methods by which they are diagnosed and the strategies of their management; and
- in general terms, the consequences of not operating compared with the benefits and risks of operations for specific abnormalities.
2 In any medical service, there is no precise point at which a new development takes place. It is an evolutionary process, determined by numerous factors which may occur separately or together. These include human technical skills, technological advances, new drugs and new strategies. There are also intangible factors such as new ideas, the courage to pursue them, research, organisation of multidisciplinary teams, and the application to the service in question of techniques and skills used in other disciplines. The many related ethical issues demand constant review.
3 Until the latter part of the 1950s very little surgical treatment was available to children with congenital heart abnormalities anywhere in the world. In 1954, W Lillehei, an American cardiac surgeon at the University of Minnesota, first used a machine to take over the work of the heart while he stopped it and opened it in order to repair an abnormality. This was soon emulated in a number of centres around the world. In 1958 the first open-heart operation on a child in the United Kingdom was performed using the heart-lung bypass machine. During the early 1960s surgery was performed on increasing numbers of children in the UK, in an increasing number of centres. There were few publications of surgical results and little was known of the expectations of survival. Operations continued to be undertaken because there was the wide recognition that without such attempts, children with the more serious congenital heart abnormalities had very little chance of surviving into adulthood. During the latter part of the 1960s and early 1970s there was an explosion of reports of surgical results and by the early 1970s paediatric cardiac surgery had been established in around half of the major regions in the UK. Patients with more complicated abnormalities tended to be referred to two or three centres with the greatest experience.
4 In the late 1970s there was increasing recognition of the need to concentrate paediatric cardiac surgery in a limited number of `supra regional' centres, especially in the case of infants under the age of 1 year. In 1983 the Department of Health established a mechanism, the Supra Regional Services Advisory Group (SRSAG), for funding a small number of highly specialised services. In 1984 the services funded in this way were expanded to include paediatric cardiac surgery, and nine centres were funded to provide this service. [3]
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Footnotes
[1] The terms `congenital heart abnormality' and `congenital heart disease' are usually interchangeable
[2] This chapter does not include the range of detailed references which would be found in an academic article. The reader requiring further detail should consult Kirklin JW, Barratt-Boyes BG. `Cardiac Surgery: Morphology, Diagnostic, Natural History, Techniques, Results and Indications' (2nd edition, 1993), Edinburgh and New York: Churchill Livingstone