Experts are offering a variety of options for specialized care for congenital heart disease patients.
Treatments received during neonatal, childhood, and adolescent years affect future adult events. In the January/February issue of Progress in Cardiovascular Diseases, ten articles explore the current understanding of adult congenital heart disease (ACHD) in survivors.
"In recognition of ACHD care currently holding potential as one of the largest and most complex growth sectors within both pediatric and adult cardiology, and as a model of long-term disease care, a greater understanding of such a continuum of outcomes and care potentials carries import for all readers," observes Michael J. Landzberg, MD, Children's Hospital and Brigham and Women's Hospital, Boston, in his introduction to the issue. "By defining and recognizing the time-dependent influences of past treatments on the aging ACHD population within a world of external forces, we learn both how to suggest refinements in pediatric interventions for children born today with congenital heart disease (CHD) so as to improve their future from that experienced by current adults, as well as where we must innovate to improve even later outcomes for current adults with CHD." Ariane J. Marellia and Michelle Gurvitz
say that advances in pediatric cardiology and cardiac surgery have resulted in a change in the mortality, prevalence, and age distribution of patients with congenital heart disease (CHD). The authors review the changing epidemiology of CHD and the impact of these trends on health services utilization and delivery in this population.
Adults with congenital heart disease (CHD) have unique medical and psychosocial needs. They require lifelong cardiac surveillance from medical providers with training and expertise in the care of adults with CHD, say Adrienne H. Kovacs and Amy Verstappen.
Consideration of the "whole" patient demands recognition of the unique medical and psychosocial challenges of adults with CHD.
Increased success in treating CHD has resulted in a fast-growing and challenging population of adults with CHD given their unique anatomy and physiology coupled with the inevitable effects of aging. A multidisciplinary approach appears to be the best strategy for these highly complex patients, says Kristine J. Guleserian.
Advances in Transcatheter Interventions in Adults With Congenital Heart Disease by Jeffery Meadows and Michael J. Landzberg
provides a broad review of the important advances in cardiac catheterization that have occurred over the past decade as they pertain to the adult with congenital heart disease, with an emphasis on recent interventional tools and techniques that have revolutionized this exciting field.
Also reviewed are some of the common multiorgan system effects of longstanding congenital heart disease (eg, renal and hepatic dysfunction, coagulation abnormalities, arrhythmias) as well as some of the unique cardiopulmonary physiology of this patient population. Sylvia Abadir and Paul Khairy
focus on recent advances and emerging therapeutic options that are providing safer solutions and increasing the effectiveness with which arrhythmias may be managed in adults with congenital heart disease, spanning pharmacotherapy to innovative interventions.
The evaluation and monitoring of the adult with CHD are demanding and ever evolving. Imaging tools are critical to the medical management and planning for reintervention. Echocardiography, multislice spiral CT, and cardiac MRI all hold an important and unique role among these imaging modalities. Advances over the past decade have been tremendous, and future advances promise to be as important, say Craig Broberga and Alison Knauth Meadows.
As maternal cardiac disease is the major cause of maternal morbidity and mortality, another article describes the circulatory changes that occur during normal pregnancy and delivery, addresses the risks posed during pregnancy by specific congenital lesions, and reviews the current data on pregnancy outcomes in patients with individual congenital defects.
Adult congenital heart disease represents a growing population of patients being referred for heart, lung, and combined heart-lung transplantation. This group of patients presents multiple unique surgical and medical challenges to transplantation owing to their complex anatomy, multiple prior palliative and corrective procedures, frequently increased pulmonary vascular resistance, and often debilitated condition, say Dana McGlothlin and Teresa De Marco.
Gary Webb, MD, Cincinnati Adolescent and Adult Congenital Heart Center, Cincinnati Children's Hospital Heart Institute, calls for a strengthening and consolidation of ACHD research. "The days of single-center observational studies have largely passed. There will be a need for more basic science and translational research and for population-based and outcome research using data resources that are increasingly and abundantly available. The focus will need to be on designing multicenter research studies and earning research grant support. Research will need to get beyond the cardiac and cardiology aspects of ACHD research and become more holistic and inclusive," he says.