Editorial
Young and Free: Over 25 Years of Seminal Contributions to Complex Congenital Heart Disease From Australia & New Zealand

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Introduction

In the second year of this journal, Timothy Cartmill (Figure 1a) provided a succinct history of the development of paediatric cardiac surgery, which had benefitted greatly from the contribution of local figures like Sir Brian Barratt-Boyes [1]. By the 1970s, three of the premier units in the world for the care of complex congenital heart disease (CHD) had been established in Australia and New Zealand (ANZ): in Auckland, Sydney and Melbourne. The tradition of multidisciplinary care established by these units – between dedicated surgeons, cardiologists, radiologists and anaesthetists – pervaded the region through generations of their trainees. The 1980s and 90s saw mortality for repair of most lesions in infancy and childhood fall to 2% overall [2]. Echocardiography and prenatal ultrasound enabled foetal detection and early accurate diagnosis, and the ready availability of prostaglandin ensured survival to transfer to tertiary referral centres. Once lesions were repaired, the technological developments available in intensive care allowed effective multi-organ support for even the smallest bodies. Cartmill concluded that, “It remains to understand the pathology more clearly, to develop the techniques … and to refine preoperative and postoperative care.” [1]

Teams in Australia and New Zealand have led too many clinical and research developments in the field of congenital heart disease in the last 25 years to list comprehensively. In this editorial, we chronicle some of the most influential and innovative work from the region. These achievements have led to a better understanding of the pathology and natural history after repair, more sophisticated techniques and better quality of care for the most high-risk groups of patients. Our region has become renowned around the world for its multi-disciplinary and multi-institutional collaborations, which are resulting in small improvements in already excellent outcomes.

Section snippets

The Causes and Inheritance of Congenital Heart Disease

Most congenital heart disease is known to develop through a complex interplay between genes and the environment [3]. Through international collaboration between basic scientists, clinicians and genetic counsellors, the team at The Children's Hospital at Westmead and the Victor Chang Research Institute in Sydney have made strides in defining the causes and inheritance of congenital heart disease. Basic science research has contributed to our understanding of normal cardiac development, and the

Nunn's Repair of Atrioventricular Septal Defect

Repair of atrioventricular septal defect (AVSD) has historically been complex and difficult to teach. In 1995, Graham Nunn described a simplified technique which allowed reproducible repair using a single patch, with applicability to most forms of AVSD. This technique has now become one of two standard approaches around the world for repairing AVSD, and is often referred to as the “Australian Technique” [20] (Figure 4).

Aortic Valve Repair

Myriad techniques exist for the treatment of neonatal and paediatric aortic

New Zealand's Commitment to Excellence in Clinical Care

Barratt-Boyes’ (Figure 1c) and Alan Kerr’s high standard of clinical achievement and technical development continues to be realised by the Green Lane team at Starship Children's Hospital in New Zealand. This is demonstrated in their world-leading published outcomes after the Norwood [26], arterial switch operation [27], Fontan conversion [28], [29], transplantation [30] and mitral valve repair [31]. Consistently, results in multi-institutional studies stand out as being better than the norm,

Disclosures

Yves d’Udekem is a consultant for companies MSD and Actelion.

Acknowledgements

The authors would like to thank Associate Professor Robert G Weintraub for his assistance in the drafting of this manuscript. Dr Yves d’Udekem is a Clinician Practitioner Fellow of the National Health and Medical Research Council of Australia (1082186).

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