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(Circulation. 2007;116:1874-1875.)
© 2007 American Heart Association, Inc.

Editorial

Congenital Heart Surgery in a Developing Country

A Few Men for a Great Challenge

Noedir A.G. Stolf, MD

From the Department of Thoracic and Cardiovascular Surgery Heart Institute, University of São Paulo Medical Center, São Paulo, Brazil.

Correspondence to Noedir Stolf, Department of Thoracic and Cardiovascular Surgery, Heart Institute–University of São Paulo Medical Center, Av Dr Eneas de Carvalho Aguiar, 44 São Paulo, Brazil 05403-000. E-mail stolf@incor.usp.br

Key Words: Editorials • developing nations • heart defects, congenital • surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

The article by Larrazabal et al¹ in this issue of Circulation can be analyzed from several points of view. The first is the humanitarian aspect involved in the decision of Dr Aldo Castañeda to return to Guatemala and start a program of congenital heart surgery. After so many contributions to congenital heart surgery as chair of the Department of Cardiovascular Surgery at the Children’s Hospital in Boston with all its available facilities, facing the difficulties of a country with tremendous social and economic problems was an example of persistence and idealism. It is also noteworthy that the recognized human and material support came from United States. Furthermore, the success of the project is measured by the increasing number of patients in each period studied, by the decrease in mortality, and especially by the training of personnel. This last aspect is well demonstrated in the case of the surgeons in that Dr Castañeda was progressively replaced in each surgical procedure. Finally, it is worth mentioning the methodology to validate the improvement in results with risk adjustment and comparison with US standards.

Article p 1882

Nevertheless, during the study period, a high percentage of simpler cases and older patients is constant. The next step could be to work on early referral and diagnosis of heart disease in the neonatal population to extend the benefits to complex cases.

Performing congenital heart surgery in developing countries is one of the greatest challenges in cardiovascular surgery. The possible options are referring the patients to other . . . [Full Text of this Article]