A New Dawn for Brazilian Pediatric Cardiac Surgery Is on the Way - Issues Around and Outside the Operating Room

ABSTRACT In some developing countries, congenital heart disease still stands out among the leading causes of death in the first year of life. Therefore, there is a great need to develop programs designed to improve outcomes in the diagnosis and surgical treatment of congenital heart disease in these nations, where children have always been and still are severely underserved. The Brazilian Public Health Care System demands universal access to treatment as a constitutional right. Therefore, an underfunded Pediatric Cardiac Surgery program is unacceptable since it will cost lives and increase the infant mortality rate. Additionally, poor funding decreases providers’ interest, impedes technological advances and multidisciplinary engagement, and reduces access to comprehensive care. Unfortunately, in most developing countries, Pediatric Cardiac Surgery progress is still the result of isolated personal efforts, dedication, and individual resilience. This article aims to present the current state of Brazilian pediatric cardiac surgery and discuss the structural and human limitations in developing a quality care system for children with congenital heart disease. Considering such constraints, quality improvement programs via International collaboration with centers of excellence, based on proper data collection and outcomes analysis, have been introduced in the country. Such initiatives should bring a new dawn to Brazilian Pediatric Cardiac Surgery.

摘要：在部分发展中国家，先天性心脏病（Congenital Heart Disease）仍是婴儿出生后第一年的主要致死病因之一。在这些儿童长期且至今仍面临医疗服务严重匮乏的国家，亟需制定相关方案以改善先天性心脏病的诊断与外科治疗效果。巴西公共卫生保健体系将普遍获得治疗权列为宪法赋予的公民权利，因此资金不足的小儿心脏外科（Pediatric Cardiac Surgery）项目绝不可取——其不仅会造成生命损失，还会推高婴儿死亡率。此外，资金匮乏还会降低医疗从业者的从业积极性，阻碍技术进步与多学科协作，并削弱患儿获取全面诊疗服务的机会。遗憾的是，在大多数发展中国家，小儿心脏外科的发展仍依赖于个人的孤立付出、奉献精神与个体韧性。本文旨在阐述巴西小儿心脏外科的当前现状，并探讨在构建先天性心脏病患儿优质诊疗体系过程中存在的结构性与人力层面的局限性。鉴于此类制约因素，该国已引入基于规范数据采集与疗效分析、与国际卓越医疗中心开展合作的质量改进项目。此类举措有望为巴西小儿心脏外科带来全新的发展曙光。