Surgery for GUCH (grown-up congenital heart disease) in a tertiary hospital of a developing country

  • Dr Rachel Haickel Nina, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Dr Vinicius Nina, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Dr José Figueiredo Neto, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Ms Isabela Silva, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Mr Alexandre Andrade, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Mr Rafael Gonçalves, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Ms Sarah Ramos, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil
  • Mr José Daniel Costa, University Hospital of the Federal University of Maranhão, São-Luis-MA, Brazil, Brazil

    • Objective: to analyze the surgical outcomes of GUCH (grown-up congenital heart disease in a tertiary south-american public hospital.
    Method: From January 2003 through June 2008 a retrospective study was performed on 63 patients(41 female) with mean age of 31.4 years (15-72 years) who were undergone to surgical correction of GUCH. All patients had a preoperative echocardiogram and angiogram for evaluation of the ventricular function, pulmonary artery pressure(PAP) and to rule out other cardiac lesions. Operations were performed under cardiopulmonary bypass through a mid-sternotomy. Logistic regression model was applied to identify predictors of adverse outcome.
    Results: Predominant pathologies were ASD in 41 cases (65,2%), VSD in 12 cases (19%) followed by combined lesions in 10 cases (15,8%). The mean systolic PAP was 40.3mmHg (20-100 mmHg). Twenty-two(34,9%) patients had PAP>35mmHg. In-hospital mortality was 1.5% (1 case). There were no late deaths. The morbidity rate was 31.7% (20 cases). The major morbid events were: arrhythmias, low CO and transient neurologic impairment. Multivariate analysis showed that preoperative PAP greater than 43 mmHg was a predictor of postoperative cardiac and neurologic dysfunction (p<0.05).
    Conclusion: Late presentation for surgery makes GUCH a very common finding in developing countries. Although it imposes a demanding clinical assessment, it can be surgically treated with low mortality and acceptable morbidity.