IJCS | Volume 31, Nº4, July / August 2018

378 Jesus et al. The wait for surgical treatment of heart disease Int J Cardiovasc Sci. 2018;31(4)374-382 Original Article Table 2 - Type of congenital heart disease of patients enrolled for elective procedure Cardiopathies n (%) Ventricular septal defect 110 (27.02) Patent ductus arteriosus 75 (18.42) Atrial septal defect 41 (10.07) Tetralogy of Fallot 35 (8.59) Congenital pulmonary stenosis 24 (5.89) Coarctation of the aorta 15 (3.68) Pulmonary atresia 12 (2.94) Ventricular septal defect + associations* 8 (1.96) Congenital aortic stenosis 8 (1.96) Atrioventricular defect 7 (1.71) Double-outlet right ventricle 5 (1.22) Congenital tricuspid stenosis 5 (1.22) Congenital mitral regurgitation 5 (1.22) Hypoplastic right heart syndrome 4 (0.98) Common arterial trunk 3 (0.73) Double inlet left ventricle 3 (0.73) Atrial septal defects + pulmonary stenosis 3 (0.73) Congenital subaortic stenosis 2 (0.49 Cor triatriatum 1 (0.24) Ebstein's anomaly 1 (0.24) Hypoplastic left heart syndrome 1 (0.24) Anomalous pulmonary venous return 1 (0.24) Cardiac aneurysm 1 (0.24) Discordant atrioventricular connection 1 (0.24) Discordant ventriculoatrial connection 1 (0.24) Double outlet left ventricle 1 (0.24) Aortic regurgitation 1 (0.24) Double mitral valve lesion 1 (0.24) Congenital pulmonary insufficiency 1 (0.24) Others † 34 (8.35) * Patent ductus arteriosus, atrial septal defect, pulmonary stenosis and coarctation of the aorta; † other congenital malformations of the tricuspid valve, other congenital malformations of the cardiac chambers and connections, congenital malformations of the cardiac septa, non- specific congenital malformation of the tricuspid valve, malformations of the coronary vessels, primary and secondary pulmonary hypertension, and unregistered ones. a deficit of 78.49%. 15 This reality can be explained by several causes, such as the lack of qualified professionals and hospital institutions with infrastructure to perform the required complex procedures. In our reality, there is also the hypothesis that the low rate of patients coming from the Lower Amazon region, Marajó island and southwest of Pará regions is due to the difficulties of access to basic care for this population, thus resulting in the underdiagnosis of congenital heart diseases and, therefore, fewer referrals to the assessed center. A highly complex service requires multiprofessional attention, with cardiac surgeons, hemodynamicists, pediatric cardiologists, anesthesiologists, pediatric intensivists, in-hospital andoutpatient clinic pediatricians, perfusionists, nurses and physical therapists. The treatment outcomes should be part of a lifelong care cycle, and not only the immediate surgical outcome. The large number of patients with cardiac malformations requires multi-institutional cooperation to achieve these goals. 16 Fundação Hospital de Clínicas Gaspar Vianna is the only referral public hospital in Pará that performs hemodynamic and surgical treatment of pediatric congenital heart disease. The mean monthly number of cardiac surgeries was similar in the study period (16.6 surgeries/month). Regarding pediatric hemodynamic procedures (diagnostic and/or therapeutic cardiac catheterization), there was an increase: in 2012, the average number of monthly procedures was 9.5; in 2013, of 9.8; and in 2014, until October, of 13.6 – it is noteworthy that this increase was accompanied by an increase in the number of diagnostic cardiac catheterizations to the detriment of therapeutic ones. The latter, in turn, accounted for only 14.85% of all therapeutic procedures. The lownumber of therapeutic cardiac catheterizations when compared todiagnostic procedures is a consequence of the absence of other diagnostic methods, such as computed tomography and cardiac magnetic resonance, due to the possible lack of devices for therapeutic percutaneous procedures. Considering that VSD, ASD, PDA, congenital pulmonary stenosis and coarctation of the aorta account for 65.2% of all diagnoses, which are malformations potentially treatable by cardiac catheterization, it can be observed that there is a low rate of these interventions in our country. Thus, investing in hemodynamic treatment is a strategy to reduce the waiting time, since the interventional treatment does not require prolonged