AN IMPORTANT consideration in regard to standards of care for children with cardiovascular problems is that the pediatricians have the responsibility for organizing a good diagnostic and surgical team. A good anesthesiologist, a competent surgeon, good nursing care, and keen postoperative observation for early signs of complications are all essential to success. The pediatricians cannot regulate the surgeon, but the standards set can require that the surgeons have met their own standards before they have charge of the pediatric surgical program. The superb results of open-heart surgery as quoted by Dr. Kirklin from the Mayo Clinic are unfortunately not a universal experience and hence recommendations for surgery in a given area must be based on local operative results.
The responsibility for operation rests clearly with the pediatrician and the pediatric cardiologist. The family grants permission for operation but their consent is given on the basis of the advice they receive from the doctor. If operation is not indicated or the risk too high, ours is the responsibility to persuade child and parent not to have an operation. To do right by the child and the family the diagnosis should be accurate, the indications for surgery should be clear, and the family should fully understand the situation. Even if the odds are overwhelmingly in favor of a successful operation, for any one patient the odds are one to one between life and death.
Cardiac operations should be undertaken only to correct or alleviate an abnormality of the heart. Indeed, the pediatrician must be certain that the child's complaints are related to the cardiac condition. The tendency is a natural one to assume that two unknowns go together.
- Copyright © 1964 by the American Academy of Pediatrics