Development of Pediatric and Congenital Heart Surgery in Latin America

Abstract

In the last 70 years, congenital heart surgery has dramatically evolved, and Latin America has completed this journey with unique regional features. Since the first ligation of a patent arterial duct by Enrique Finochietto in 1941 in Buenos Aires, the development of congenital heart surgery was deeply influenced by funding restrictions and scarcity of technology. However, the determined work of cardiovascular surgery pioneers as Hugo Filipozzi, Euriclides Zerbini, and Adib Jatene in Brazil; Helmut Jaeger in Chile; Hugo Baz and Clemente Robles in Mexico; Alberto Bejarano in Colombia; and Mario Brea and Fernando Tricerri in Argentina made cardiac surgery with cardiopulmonary bypass available by the late 1950s. In the following five decades new generations of cardiovascular surgeons received the legacy of these outstanding leaders and made several important contributions to the field in tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, single ventricle, truncus arteriosus, heart transplantation, and many others. Many centers in Latin America routinely perform congenital heart disease surgery with excellent results, covering the entire spectrum from the newborn to the adult congenital heart patient. The most important challenge that remains is to provide access to care to all children with congenital heart disease in Latin America, since currently only 42% of them receive surgical treatment.

Global, regional, and national time trends in mortality for congenital heart disease, 1990–2019: An age-period-cohort analysis for the Global Burden of Disease 2019 study

“… 36 Ecuador is a middle-SDI country with increasing mortality risks in recent periods and birth cohorts, and 86% of patients with newly diagnosed CHD each year do not receive timely cardiac surgery. 31 Mexico is a middle-SDI country but with all-age mortality 1.3-fold higher than the global level and worsening trends over time and cohort. 37 The Mexican health-care system is fragmented, and CHD patients are treated in different institutions without integrated and uniform standards of care.…”

“… 28 Despite these gains, there is room for improvement in Brazil and China as their all-age mortality remains 2.5 to 4.5 times higher than that of high-SDI countries. In Brazil, nearly 60% of newly diagnosed patients are not financially covered for cardiac surgery, 31 and specialised centres for paediatric cardiac surgery remain poorly structured and inadequately funded. 32 In China, CHD mortality in rural children under 5 was about two-fold higher than in urban children, 33 with underprivileged children having suboptimal outcomes after surgery.…”

Fifth “Jatene Lecture on Surgical Innovation”: Innovation in Congenital Heart Surgery: Contributions From South America

“…Hugo Felipozzi performed the first selective right heart shunt in October 1955 for a patient with pulmonary stenosis at Sabbado D'Angelo Cardiology Institute in São Paulo Brazil. 11 Zerbini, Bittencourt, and Adib Jatene founded the "Escola Brasileira" at Hospital das Clinicas, at the University of São Paulo. The construction of cardiopulmonary bypass machines of disc oxygenators by 1958 at "Oficina Tecnica" of the Hospital das Clinicas, allowed for the treatment of patients with rheumatic fever and congenital heart disease.…”

“…Hugo Felipozzi performed the first selective right heart shunt in October 1955 for a patient with pulmonary stenosis at Sabbado D'Angelo Cardiology Institute in São Paulo Brazil. 11…”

The South American paradigm of Congenital Heart Disease care

“…This highlighted the potential increase in congenital cardiac procedures if the number of operations and survivors continued to rise. The study by Kreutzer and collaborators acknowledged improvements in healthcare policies regarding congenital heart defect coverage by 2011, particularly in the southern hemisphere 1 . For instance, Chile and Uruguay showed excellent coverage, with 80% to 90% of children in need of congenital heart disease surgery receiving treatment.…”