Progress Report on Infants with Serious Cardiac Malformations

Two aims of an inquiry into cardiovascular emer-gencies in the first year of life are to determine the incidence of malformations and to assess the prog-nosis, especially the changing prognosis which may be expected to reflect changing methods of manage-ment. The two are closely linked because any general conclusion reached on the subject of prog-nosis must take into account not only the diagnostic and therapeutic techniques available at the time, but also the incidence of remediable and irremedi-able malformations in the population. A previous survey (Coleman, 1965) disclosed that at the Royal Hospital for Sick Children, Glasgow, the relative incidence of malformations was not identical with that elsewhere, and also that the prognosis for this group of patients was so poor that more vigorous diagnostic and therapeutic measures were indicated. The present report reviews data from the same source obtained during subsequent years. CLINICAL MATERIAL All patients in the first year of life admitted to the Royal Hospital for Sick Children, Glasgow, during the 3-year period beginning October 1, 1962, because of cardiovascular disease with symptoms (breathlessness, cyanosis, congestive cardiac failure) were followed to the end of the first year of life or until death if this occurred earlier. Out of a total of 154 patients, the diagnosis in 29 was made by clinical, radiographic, and electrocardio-graphic examination only; in 125 this information was supplemented by evidence supplied by cardiac catheter-ization and angiocardiography (82), thoracotomy (38), or necropsy (67). A second group of patients, included to provide additional information, consisted of all those admitted with the same symptoms in the same age period during the 12 months which ended on March 31, 1968. In this group of 60 patients the diagnosis in 12 patients was made on the basis of clinical, radiographic, and electrocardiographic findings only,but was confirme