Medical and surgical approaches to children with trisomy 13 and 18 are evolving, and an increasing number of patients are being considered for simple and complex cardiac procedures. This review describes how the shifts in medical and social considerations for children with trisomy 13 and 18 mirror the shifts that occurred 50 years ago for children with trisomy 21. Yet the variability in cardiac lesions, and variability in non-cardiac comorbidities, is much greater for patients with trisomy 13 and 18 than for those with trisomy 21. That variability, combined with the severe neurologic impairment in survivors, complicates the current risk: benefit balance of surgical intervention. Consistent approaches to care for these patients should be built on an evidence base, and should include contributions from specialists in medical ethics and palliative care.

中文翻译：

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在13三体和18三体儿童中进行心脏外科手术的伦理考虑。

正在发展针对13号和18号三体症儿童的医学和外科手术方法，并且考虑将越来越多的患者用于简单和复杂的心脏手术。这篇综述描述了13和18三体性儿童的医学和社会考虑因素的变化如何反映了50年前21三体性儿童的变化。然而，心脏病变的变异性和非心脏合并症的变异性更大对于13号和18号三体患者，与21号三体性患者相比，这种变异性加上幸存者的严重神经功能缺损使当前的风险复杂化：手术干预的收益平衡。对这些患者的一致护理方法应建立在证据基础上，