Number of procedures (The Netherlands, 15.5 million inhabitants, birthrate 200 000): About 1,000 diagnostic and therapeutic cardiac catheterisations in children annually in the following five years. The contribution of therapeutic catheterisations - currently around 150 - will gradually rise to 250 as a result of developments in the field. The number of diagnostic catheterisations will fall slightly in view of the greater potential for using non-invasive diagnostic imaging techniques. The Committee expects the number of heart operations in children with congenital heart defects to level out at approximately 950 a year, which is the current figure.
Requirements:Patients with congenital heart disease should be treated at centers where interventional cardiology and cardiac surgery are fully-fledged specialists and there is extensive formalized cooperation between specialists in both fields. A pediatric cardiac center should have at least four pediatric cardiologists (two specialists working in non-invasive diagnostic and treatment and two in interventional cardiology) and two pediatric cardiac surgeons. The annual number of diagnostic catheterisations performed by each pediatric interventional cardiologist should rise to at least 75 and the number of therapeutic catheterisations to between 25 and 40. The number of operations performed by each pediatric cardiac surgeon should increase to at least 100. The care infrastructure should be similar to that in a university children's hospital; continuity of care, expertise and a child-centered approach are essential. The registration of indications, treatments and follow-up should be made obligatory. Implications for practice: Treatment of children with congenital heart defects must be concentrated in three of the seven centers which exist at present.
Other output or dissemination activity: Update report: expected in 2000; Acceptance of recommendations: accepted by the Minister of Health, Welfare and Cultural Affairs; the report will be used as a basis for a Planning Decree under section 18 of the Hospital Provision Act for tertiary referral centers. Changes to practice: concentration of facilities will be effectuated (in the long run).