Anita Saxena1, Jay Relan2, Ravi Agarwal3, Neeraj Awasthy4, Sushil Azad5, Manisha Chakrabarty6, Kulbhushan S Dagar4, Velayoudam Devagourou2, Baiju S Dharan7, Saurabh K Gupta2, Krishna S Iyer5, M Jayranganath8, Raja Joshi9, B R J Kannan10, Ashish Katewa11, Vikas Kohli6, Nageswara Rao Koneti12, Shyam S Kothari2, K M Krishnamoorthy7, Snehal Kulkarni13, Rohit Manoj Kumar14, Raman Krishna Kumar15, Sunita Maheshwari16, Krishna Manohar17, Ashutosh Marwah18, Smita Mishra18, Smruti R Mohanty13, Kona Samba Murthy19, P V Suresh20, S Radhakrishnan21, Palleti Rajashekar2, Sivasubramanian Ramakrishnan2, Nitin Rao22, Suresh G Rao13, Chinnaswamy Hm Reddy16, Rajesh Sharma23, Krishnanaik Shivaprakasha24, Raghavan Subramanyan25, R Suresh Kumar26, Sachin Talwar2, Munesh Tomar27, Sudeep Verma28, Vijayakumar Raju29. 1. All India Institute of Medical Sciences, New Delhi, India. Correspondence to: Dr Anita Saxena, DM (Cardiology), Professor, Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110 029, India. anitasaxena@hotmail.com. 2. All India Institute of Medical Sciences, New Delhi, India. 3. Madras Medical Mission, Chennai, India. 4. Max Super Speciality Hospital, New Delhi, India. 5. Fortis Escorts Heart Institute, New Delhi, India. 6. Apollo Hospitals, New Delhi, India. 7. Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India. 8. Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. 9. Sir Ganga Ram Hospital, New Delhi, India. 10. Vadamalayan Hospitals, Madurai, Tamil Nadu, India. 11. Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India. 12. Care Hospital, Hyderabad, Telangana, India. 13. Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India. 14. Postgraduate Institute of Medical Education and Research, Chandigarh, India. 15. Amrita Institute of Medical Sciences, Kochi, Kerala, India. 16. Narayana Institute of Cardiac Sciences, Bangalore, Karnataka, India. 17. Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India. 18. Jaypee Hospital, Noida, Uttar Pradesh,India. 19. Innova Children's Heart Hospital, Hyderabad, Telangana, India. 20. Narayana Hrudayalaya, Bangalore, Karnataka, India. 21. 4Fortis Escorts Heart Institute, New Delhi, India. 22. Star Hospital, Hyderabad, Telangana, India. 23. Jaypee Hospital, Noida, Uttar Pradesh, India. 24. HN Reliance Hospital, Mumbai, Maharashtra, India. 25. Frontier Lifeline Hospital, Chennai, India. 26. Believers International Heart Centre, Thiruvalla, Kerala, India. 27. Nutema Hospital, Meerut, Uttar Pradesh, India. 28. Krishna Institute of Medical Sciences, Secunderabad, Telangana, India. 29. GKNM Hospital, Coimbatore, Tamil Nadu, India.
Abstract
JUSTIFICATION: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA. OBJECTIVES: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS: Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.
JUSTIFICATION: A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS: Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on 10th and 11th of August 2018 at the All India Institute of Medical Sciences, New Delhi. The meeting was supported by Children's HeartLink, a non-governmental organization based in Minnesota, USA. OBJECTIVES: To frame evidence based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS: Evidence based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus and others), obstructive lesions (pulmonary stenosis, aortic stenosis and coarctation of aorta) and cyanotic congenital heart diseases (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein anomaly and others). In addition, protocols for follow-up of post surgical patients are also described, disease wise.