Common Adult Congenital Heart Disease Issues
There are more adults than children living with congenital heart disease (CHD) in the United States. Most adults with congenital heart disease should be seen at least periodically by adult congenital heart disease (ACHD) specialists. The general cardiology consultant also has a unique opportunity to improve the care of patients with ACHD by improving access to care, while patients are interacting with the healthcare system for other reasons such as noncardiac surgery or pregnancy. This chapter describes the epidemiology of ACHD, issues with accessing healthcare, and transitioning patients from a pediatric to adult model of care. We will outline general approaches including society guidelines to common issues including hypertension, dyslipidemia, heart failure and transplantation, arrhythmias, liver disease, hyperviscosity, preoperative risk assessment, imaging, pregnancy, contraception, exercise, and infective endocarditis. Finally, we will briefly review some of the more commonly encountered forms of cyanotic and acyanotic ACHD and describe surgical treatments including shunts and the Fontan palliation procedure.
KeywordsAdult congenital heart disease Guidelines Transition Preoperative risk assessment Pregnancy Arrhythmias Cyanosis Shunts
- 6.Russo CA, Elixhauser A. Hospitalizations for birth defects, 2004. Rockville, MD; 2007.Google Scholar
- 7.Sable C, Foster E, Uzark K, Bjornsen K, Canobbio MM, Connolly HM, et al. Best practices in managing transition to adulthood for adolescents with congenital heart disease: the transition process and medical and psychosocial issues. Circulation. 2011;123:1454–85. https://doi.org/10.1161/CIR.0b013e3182107c56.CrossRefPubMedGoogle Scholar
- 13.Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Hear Lung Transplant. 2016;35:1–23. https://doi.org/10.1016/j.healun.2015.10.023.CrossRefGoogle Scholar
- 16.Vongpatanasin W, Brickner ME, Hillis LD, Lange RA. The Eisenmenger syndrome in adults. Ann Intern Med. 1998;128:745–55. https://doi.org/10.7326/0003-4819-128-9-199805010-00008.CrossRefPubMedGoogle Scholar
- 23.Miller E, Eichelberger J. Congenital heart disease in pregnancy. periFACTS Ob/Gyn Acad. 2016.Google Scholar
- 26.Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014;148:e1–132. https://doi.org/10.1016/j.jtcvs.2014.05.014.CrossRefPubMedGoogle Scholar
- 29.Gatzoulis MA, Webb GD, Daubeney PEF, editors. Diagnosis and management of adult congenital heart disease. 3rd ed. Philadelphia: Elsevier; 2018.Google Scholar
- 32.Otto C. Textbook of clinical echocardiography. 5th ed. Philadelphia: Elsevier; 2013.Google Scholar
- 34.Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, et al. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45:2160–236. https://doi.org/10.1161/STR.0000000000000024.CrossRefPubMedGoogle Scholar
- 37.Messé SR, Gronseth G, Kent DM, Kizer JR, Homma S, Rosterman L, et al. Practice advisory: recurrent stroke with patent foramen ovale (update of practice parameter). 2016. https://doi.org/10.1212/WNL.0000000000002961.