Surgical management of the neonate with congenital heart disease.

Despite the multiplication of specialised centres and a fall in the birth rate, paediatric cardiac units have seen a steady increase in the number of infants with congenital heart defects operated on during the neonatal period. This changing pattem is the result of continuing advances in neonatology, early detection and better management of the neonate with a congenital heart defect, and the tendency, rightly or wrongly, to operate on more complex defects. Advances in neonatology with improved infant care and ventilatory support for infants with respiratory distress syndrome have increased the neonatal survival rate. Hence the increase in the number of premature infants with a persistent ductus ateriosus who require surgical closure, often after a trial of treatment with indomethacin. More specifically the preoperative status of neonates with congenital heart defects has been greatly improved by the introduction of prostaglandins and a trend to non-invasive diagnosis. Conventional clinical diagnosis of congenital heart defects by physical examination, chest radiography, and electrocardiography is often unreliable, particularly in the neonatal period. For this reason cardiac catheterisation and angiocardiography have for many years been the standard diagnostic methods in this age group. Cross sectional echocardiography has changed the indications and need for cardiac catheterisation. Neonates have a technically excellent subcostal and suprasternal window that allows good definition of the intracardiac anatomy. Most congenital cardiac malformations can be diagnosed by cross sectional echocardiography in the neonate. The anatomical definition of the anomaly together with