Advances in the Care of Adults With Congenital Heart Disease

Abstract

The significant decline in mortality among children and adolescents with congenital heart disease (CHD) is associated with an increasing prevalence of CHD in adults, particularly those with moderate to severe defects. As a significant percentage of adolescents and young adults are lost to follow-up in the transition from pediatric to adult care, they may present for elective procedures with substantial CHD-associated morbidity. In addition to the specific cardiac defect, the procedures performed, and the current pathophysiological status, several factors should be considered when managing the adult with CHD. These include the type of setting (adult vs pediatric institution); surgeon (pediatric vs adult cardiac surgeon); coexisting diseases associated with CHD, such as coronary artery disease, hepatic dysfunction, renal dysfunction, cerebrovascular accidents, myopathy, and coagulation disorders; acquired diseases of aging; pregnancy; and psychosocial functioning. The current status of the management of common and important congenital cardiac defects is also described.

Overall Hospital Cost Estimates in Children with Congenital Heart Disease: Analysis of the 2012 Kid’s Inpatient Database

“…These results are not surprising. Due to advances made in surgical techniques [11] and improvements in diagnosis and medical treatments [12], an increasing number of children with CHD now undergo non-cardiac surgeries or require hospital admission due to the fact that a substantial proportion of children with CHD have or develop significant non-cardiac conditions [9]. Higher mortality has been reported in children with CHD undergoing non-cardiac surgery as compared to children without CHD [1].…”

Noteworthy Literature in 2015

“…Nasr and Kussman provide an overview of CHD-associated factors that need to be considered in this patient population. 60 In addition to the specific cardiac defect, the proposed procedure, and the patient’s current pathophysiological state, several other factors should be considered in the perioperative management of the adult with CHD. These include the type of setting (adult vs pediatric institution); coexisting diseases such as coronary artery disease, hepatic dysfunction, renal dysfunction, cerebrovascular accidents, myopathy, and coagulation disorders; and acquired diseases of aging and pregnancy.…”

Editorial

“…The number of adults living with CHD far exceeds the number of children with CHD. The article by Nasr and Kussman 1 reviews these data and the CHD-associated morbidity faced by survivors with CHD. The perioperative planning for these patients must include not only an understanding of their CHD and current physiological status but also any additional “adult” comorbidity such as coronary artery disease.…”