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In these regions, economic growth has enabled the development of cardiac units that manage patients with CHD presenting later than would be ideal, often after the window for early stabilisation \u2013 transposition of the great arteries, coarctation of the aorta \u2013 or for lower-risk surgery in infancy \u2013 left-to-right shunts or cyanotic conditions. As a result, patients may have suffered organ dysfunction, manifest signs of pulmonary vascular disease, or the sequelae of profound cyanosis and polycythaemia. Late presentation poses unique clinical and ethical challenges in decision making regarding operability or surgical candidacy, surgical strategy, and perioperative intensive care management.<\/jats:p>","DOI":"10.1017\/s1047951117002591","type":"journal-article","created":{"date-parts":[[2017,12,4]],"date-time":"2017-12-04T09:59:07Z","timestamp":1512381547000},"page":"S31-S39","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":39,"title":["Management of late presentation congenital heart disease"],"prefix":"10.1017","volume":"27","author":[{"given":"Parvathi U.","family":"Iyer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillermo E.","family":"Moreno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz","family":"Fernando Caneo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tahira","family":"Faiz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara S.","family":"Shekerdemian","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna S.","family":"Iyer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2017,12,4]]},"reference":[{"key":"S1047951117002591_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.siny.2013.04.007"},{"key":"S1047951117002591_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/S0300-8932(02)76734-1"},{"key":"S1047951117002591_ref8","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000329"},{"key":"S1047951117002591_ref50","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200605-694OC"},{"key":"S1047951117002591_ref44","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.8.2226"},{"key":"S1047951117002591_ref38","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-010-9679-8"},{"key":"S1047951117002591_ref41","doi-asserted-by":"publisher","DOI":"10.1177\/2150135113515487"},{"key":"S1047951117002591_ref36","first-page":"II123","volume-title":"Circulation","volume":"110","author":"Kang","year":"2004"},{"key":"S1047951117002591_ref18","first-page":"446","article-title":"Atrial septal defect in adults: does repair always mean cure?","volume":"103","author":"Lopes","year":"2014","journal-title":"Arq Bras Cardiol"},{"key":"S1047951117002591_ref46","doi-asserted-by":"publisher","DOI":"10.1097\/00008480-200106000-00005"},{"key":"S1047951117002591_ref32","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2069.149516"},{"key":"S1047951117002591_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747-0803.2011.00611.x"},{"key":"S1047951117002591_ref45","doi-asserted-by":"crossref","first-page":"147","DOI":"10.4103\/0974-2069.74045","article-title":"Management of perioperative low cardiac output state without extracorporeal life support: What is feasible ?","volume":"3","author":"Kumar","year":"2010","journal-title":"Ann Pediatr Cardiol"},{"key":"S1047951117002591_ref24","doi-asserted-by":"publisher","DOI":"10.1111\/chd.12162"},{"key":"S1047951117002591_ref22","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht437"},{"key":"S1047951117002591_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2009.05.047"},{"key":"S1047951117002591_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(99)01069-3"},{"key":"S1047951117002591_ref4","doi-asserted-by":"publisher","DOI":"10.1017\/S1047951107001588"},{"key":"S1047951117002591_ref48","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31821b82a6"},{"key":"S1047951117002591_ref2","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-006-1452-7"},{"key":"S1047951117002591_ref42","doi-asserted-by":"publisher","DOI":"10.1016\/0003-4975(95)00373-S"},{"key":"S1047951117002591_ref39","doi-asserted-by":"publisher","DOI":"10.1510\/icvts.2010.243832"},{"key":"S1047951117002591_ref35","doi-asserted-by":"publisher","DOI":"10.1016\/S1010-7940(96)01065-2"},{"key":"S1047951117002591_ref11","doi-asserted-by":"publisher","DOI":"10.1253\/circj.CJ-13-1263"},{"key":"S1047951117002591_ref31","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2069.84651"},{"key":"S1047951117002591_ref12","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(98)00956-4"},{"key":"S1047951117002591_ref7","doi-asserted-by":"publisher","DOI":"10.1086\/675995"},{"key":"S1047951117002591_ref9","doi-asserted-by":"crossref","unstructured":"Galie N , Humbert M , Vachiery JL , et al. 2015 ESC\/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. 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