Micro-Economic Impact of Congenital Heart Surgery: Results of a Prospective Study from a Limited-Resource Setting
Background: There are great discrepancies in the quality and level of care offered to patients with Down’s syndrome and a structural heart defect. While this is well recognized, there are few comparative data in the current era. Aim: To compare the level of care offered, and the outcome of three cohorts of children with Down’s syndrome and congenital heart disease, from three tertiary referral centers. Methods: A continuous case series of patients referred to each of the tertiary referral centers was followed up to evaluate the treatment and outcome. Results: Early diagnosis and routine early repair of the heart defect with good outcome is the norm in the developed world. This contrasts with late presentation with congestive heart failure and failure to thrive, lack of early and appropriate therapy, a high rate of loss of followup, and a low rate of timely correction in the developing world. Given appropriate resources and training, excellent surgical results can be obtained universally. Conclusion: While the majority of children with Down’s syndrome and a structural heart defect can be adequately treated to ensure long term survival and a good quality of life, such therapeutic options are not universally available or applied.