ABSTRACT
ustification: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However,these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required whenrecommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and mayhave co-existing morbidities and malnutrition. Process: Guidelines emerged following expert deliberations at the National ConsensusMeeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of MedicalSciences, New Delhi. The meeting was supported by Children’s HeartLink, a non-governmental organization based in Minnesota, USA.Objectives: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heartdiseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases.Recommendations: Evidence based recommendations are provided for indications and timing of intervention in common congenitalheart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductusarteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heartdiseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebsteinanomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
ABSTRACT
Percutaneous transluminal coronary angioplasty with stent implantation is a universally accepted therapeutic option for patients with coronary artery disease. Since introduction in 1977, angioplasty techniques have been greatly improved; the availability of better hardware, greater operator experience, better patient selection and the judicious use of adjunctive therapy like heparin, clopidogrel, platelet receptor antagonists like abciximab and the use of atherectomy/rotablator in given situations has greatly improved procedural outcome today. Angioplasty alleviates symptoms in patients with stable angina and also in unstable angina especially in high risk patients like those with pulmonary oedema, cardiogenic shock or patients refractory to conventional modes of therapy, though cost may be a prohibiting factor. The outcome of angioplasty in diabetic patients is universally poor and bypass surgery is always a better option. Women with coronary artery disease tend to have complex lesions with a sub-optimal outcome and a higher incidence of restenosis. Use of abciximab is always beneficial in both men and women.