Challenges on the management of XXXX in developing countries.

@entity1 @entity600 @entity299 @entity6413 @entity65
INTRODUCTION: While in developed countries prenatal diagnosis is currently used to detect @entity299 ( @entity299 ) before birth, in developing countries only a minority of @entity1 with @entity299 is detected and few benefit from surgical treatment. Having created a referral unit for diagnosis and treatment of @entity65 in a resource-deprived country we designed a study aiming at describing the spectrum and characteristics of @entity299 and discuss the challenges of its management. POPULATION AND METHODS: We studied retrospectively all @entity1 assisted at a referral unit between 2001 and 2007, collecting epidemiological, clinical, echocardiographic and surgical data from hospital files. RESULTS: We studied 534 @entity1 with median age at diagnosis of 4 years (range 0-79); 296 were females (55.4%). Only 282 (52.8%) @entity1 were diagnosed under the age of two years, and complications were present in 155 (29.0%) at time of diagnosis. We operated 196 @entity1 with mean age of 8  10 years. Only 29 of the 111 complex defects were considered for surgery. The 30-days post-operative mortality was 8/196 (4.0%). The most important post-surgical complications were @entity6413 (22). DISCUSSION: A pattern of late presentation accompanied by high rate of complications was found. In resource-deprived settings the approach to the management of @entity299 emphasizes the treatment of "curable" @entity600 . Surgery for @entity299 in these settings must be linked to early detection and a referral system in which general practitioners, pediatricians, obstetricians and cardiologists interact in the design and implementation protocols for diagnosis, management and follow-up of @entity1 .
