ETICKÉ,PSYCHO-SOCIÁLNÍ,LEGISLATIVNÍA EKONOMICKÉ ASPEKTY CHIRURGICKÉ LÉČBYSYNDROMU HYPOPLASTICKÉHO LEVÉHO SRDCE

Ethical,Psycho-social,Legislative and Economical Aspects of the Surgical Treatment of HypoplasticLeft Heart Syndrome

Hypoplastic left heart syndrome (HLHS)represents a lethal congenital heart disease,which used to be consideredinoperable.The improvement of results of cardiac surgery in neonates improved also the prognosis of patients withthis heart lesion.HLHS,however,continues to be an unresolved problem from ethical,psychological,social andeconomical points of view.Opinions regarding the care for these patients depend on economical,political,culturaland religious factors.Based on recent experience it is evident,that HLHS is an operable disease in a child,whowithout surgery would otherwise die.Approximately 40%of patients with HLHS can live 15 years after surgery.The long-term prognosis remains,however,unclear.Because of the need of demanding care for a patient with HLHS,it is necessary to see also the quality of life and hear the opinion of parents.Psychomotor development and the qualityof life may be altered by complications.An individualized approach in fetuses and neonates with HLHS on the basisof prenatal diagnosis,analysis of risk factors,provision of detailed informations to parents and indications for surgeryin neonates having chance for an acceptable result is considered to be the most acceptable solution.In the future itwill be necessary to concentrate the research on prenatal diagnostics,treatment and postoperative follow-up includingpsychomotor development and quality of life.In the preparation of legislative,which would reflect more sensitivelythe contemporary possibilities of medicine and at the same time regard the problems of health care organization,aswell as social and economic aspects,narrow interdisciplinary cooperation will be required.

Key words:
circulation,heart,congenital heart disease,hypoplastic left heart syndrome,surgical treatment,ethics,psychology,legislative.