In summary, cardiac surgery for adults with @entity1032 raises a series of controversial legal, economic, ethical, medical, and nursing dilemmas. During the past 20 years, many improvements have taken place in the care of these @entity1 . However, in the future, judicial and statutory mandates requiring high-quality medical care for @entity1 with @entity1032 may conflict increasingly with hospital cost-control legislation and thereby affect clinical decisions. For example, it is conceivable that elective repair of an ostium secundum @entity118 in an asymptomatic @entity1 will expend the limited resources necessary to carry out emergency revascularization in a symptomatic @entity1 with impending @entity583 . This issue becomes even more delicate when the asymptomatic @entity1 is a @entity1032 ward of the state, and the symptomatic @entity1 is a middle-aged @entity1 supporting a wife and several college-age @entity1 . There may be no easy solution to this problem, and it will provide the grist for many bioethicists. Fortunately, from a practical point of view, we do not currently have to choose between these @entity1 to receive treatment. Our hope is that health care for @entity1032 @entity1 will not be compromised. We believe that decisions about @entity1 management should be based on enlightened clinical judgment rather than on preconceived notions about this population. In the quest for optimal health care delivery, the special needs of these @entity1 should be considered when cardiac catheterization and possible cardiac surgery are contemplated. Although we have presented an approach to a @entity1 with @entity299 requiring cardiac surgery, we believe that this approach can be utilized for any retarded @entity1 requiring acute medical care. Currently, because there has not been much training in this area, many physicians and nurses lack first-hand experience in caring for the @entity1032 . This inexperience may lead to difficulty in making appropriate decisions. Therefore, we advocate additional exposure in medical and nursing school curricula to the complex health care needs of this population. In conclusion, there appear to be two major issues that pose dilemmas: first, acceptance of the rights of this population to optimal medical management and, second, implementation of appropriate diagnostic and therapeutic strategies.

Cardiac surgery for adults with XXXX . Dilemmas in management.

@entity1 :: ('9606', 'Species') :: ['children', 'patients', 'patient', 'man', 'persons'] @entity1032 :: ('MESH:D008607', 'Disease') :: ['mental retardation', 'mentally retarded'] @entity583 :: ('MESH:D009203', 'Disease') :: ['myocardial infarction'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac disease'] @entity118 :: ('MESH:D006344', 'Disease') :: ['atrial septal defect']
@entity1032 :: (MESH:D008607,Disease) :: ['mental retardation']
