Congenital Heart Disease
At Birth : 6~10 / 1,000 live birth
Natural Survivor at puberty
(Presurgical era) : 5 ~ 15 %
Natural & Unnatural Adult Survivor
(Surgical era) : over 85 %
‘Congenital Heart Disease’
Korean experience during past 50 Years
Heung Jae Lee
Professor of Pediatrics, Sungkyunkwan University School of Medicine
Samsung Medical Center, Seoul, Korea
Surgical Landmarks in Korea

1953,
Pulmonary stenosis

1957,
TOF shunt

1958,
PDA ligation

1959,
Open heart surgery (VSD)

1978,
Fontan op

1985,
Arterial switch op for TGA
 Balloon valvuloplasy for Valvar PS
Open Heart Surgery in Korea
 August 6th 1959
 OHS for 8yr-old girl with VSD
under cardiopulmonary bypass !!
 YK Lee, CY Hong et al
 First trial in Korea
Cardiac Surgery for CHD in Korea
[US $]
The
Korean
Heart
Foundation
10000
6000
5000
5000
4000
4000
First
Open
Heart
Surgery
1000
1000
1000$
100$
0
5000$
2000$
2000
2000
Korean
r
War
0
GNP
The
oversea
charity
operation
National
Social
Security
System
3000
3000
10000$
*
*
'55 '59 '61 '63 '65 '67 '69 '71 '73 '75 '77 '79 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03
[Year]
Early & mid 1970th in Korea
Mrs. Hodges save over 3,300 Korean kids with CHD in 1970th
Early 1980th in Korea
‘KHF-Pediatric Heart Fellowship’ program
Support Over 20,000 Kids during last 25 years
Mrs. Lee Soon Ja
Congenital Heart in Korea ....
Where are we now ??
Congenital Heart Op (SMC 2001)
n = 428
Intervention Vs OP in PDA
(Excluding NICU cases)
Percentile Profile of Current Management of
CHD in Korea : 1992-2000
Cardiac surgery without Catheterization
 VSD
 ASD
 TOF
 Neonatal PDA
Catheterization required
when complete segmental
analysis is not possible.
 CoA/ IAA
 TAPVR, Truncus Arteriosus
 Critical AS in newborn
 Shunt op. in newborn
 Congenital Valvular Heart Ds (MR etc)
 TGA with IVS
Impact of fetal diagnosis of
congenital heart disease
in Korea
Outcome of fetal Diagnosis
(2000~2001)
Diagnosis
TOP*
FDIU**
Op
Neonatal
death
VSD (n=54)
17 (31.4%)
1
4
1
TOF (n=40)
21 (52.5%)
Malpositions (n=25)
12 (48.0%)
PS (n=24)
1 (7 .1 %)
2
1
DORV (n=20)
11 (55.0%)
2
PA/IVS (n=16)
5 (31.2%)
1
7
1
HLHS (n=15)
11 (73.3%)
1
2
2
C-AVSD (n=13)
7 (53.8%)
D-TGA (n=8)
3 (37.5%)
0
5
COA (n=8)
3 (37.5%)
0
1
TOP*: termination of Pregnancy
1
FDIU ** : Fetal death Intra Uterine
‘ Fetal Echo Effect’ in Korea

Rate of termination of pregnancy (TOP)
33.2% in ’98-’99 period, 35.8% in ’00-’01 period
Associated with early diagnosis and associated extracardiac
malformations including chromosomal anomaly
Perinatal mortality & morbidity of the CHDs which
requires neonatal cardiac procedure is improving
through the planned delivery at the cardiac center

- 100% survival of arterial switch operation in cases with TGA
with IVS in ’98-’99 period( 5 cases )
- The improved result of neonatal balloon angioplasty in cases
with critical PS and PA IVS
We are now
in the Era of……
 Neonatal/Infant Cardiac Surgery
 Dx. Era of Echocardiography & MRI
 Catheter Intervention
 Fetal & Perinatal Cardiology
 Grown Up Congenital Heart (GUCH)
 Molecular-genetic Approach, CATCH 22 etc.
Cardiac Surgery for CHD in Korea
[US $]
The
Korean
Heart
Foundation
10000
6000
5000
5000
4000
4000
First
Open
Heart
Surgery
1000
1000
1000$
100$
0
5000$
2000$
2000
2000
Korean
r
War
0
GNP
The
oversea
charity
operation
National
Social
Security
System
3000
3000
10000$
*
*
'55 '59 '61 '63 '65 '67 '69 '71 '73 '75 '77 '79 '81 '83 '85 '87 '89 '91 '93 '95 '97 '99 '01 '03
[Year]
Two major factors for the success
Heart to Heart Project;
With Vietnamese Kids & Doctors at SMC
1) Rapid economic development & Active social supporting systems
(such as social security system and philanthropic organizations)
2) Overseas training for medical experts and their commitment.