Changing Landscape of Congenital Heart Disease

Abstract

Congenital heart disease is the most frequently occurring congenital disorder affecting ≈0.8% of live births. Thanks to great efforts and technical improvements, including the development of cardiopulmonary bypass in the 1950s, large-scale repair in these patients became possible, with subsequent dramatic reduction in morbidity and mortality. The ongoing search for progress and the growing understanding of the cardiovascular system and its pathophysiology refined all aspects of care for these patients. As a consequence, survival further increased over the past decades, and a new group of patients, those who survived congenital heart disease into adulthood, emerged. However, a large range of complications raised at the horizon as arrhythmias, endocarditis, pulmonary hypertension, and heart failure, and the need for additional treatment became clear. Technical solutions were sought in perfection and creation of new surgical techniques by developing catheter-based interventions, with elimination of open heart surgery and new electronic devices enabling, for example, multisite pacing and implantation of internal cardiac defibrillators to prevent sudden death. Over time, many pharmaceutical studies were conducted, changing clinical treatment slowly toward evidence-based care, although results were often limited by low numbers and clinical heterogeneity. More attention has been given to secondary issues like sports participation, pregnancy, work, and social-related difficulties. The relevance of these issues was already recognized in the 1970s when the need for specialized centers with multidisciplinary teams was proclaimed. Finally, research has become incorporated in care. Results of intervention studies and registries increased the knowledge on epidemiology of adults with congenital heart disease and their complications during life, and at the end, several guidelines became easily accessible, guiding physicians to deliver care appropriately. Over the past decades, the landscape of adult congenital heart disease has changed dramatically, which has to be continued in the future.

Three year experience of a clinical cardiovascular genetics program for infants with congenital heart disease

“…Congenital heart disease (CHD) is the most common birth defect and a significant cause of neonatal morbidity and mortality . Survival rates for even the most severe forms of critical CHD have improved significantly in the modern era, shifting research into focusing on the ability to improve or modify the morbidities associated with surviving critical CHD . One of the many considerations for a patient with CHD is the etiology of their malformation and genetic assessment of CHD is becoming more emphasized in the care of these patients .…”

“…1 Survival rates for even the most severe forms of critical CHD have improved significantly in the modern era, shifting research into focusing on the ability to improve or modify the morbidities associated with surviving critical CHD. 2 One of the many considerations for a patient with CHD is the etiology of their malformation and genetic assessment of CHD is becoming more emphasized in the care of these patients. 3,4 Participation of a medical geneticist in care for individuals with CHD has been repeatedly recommended and shown to be beneficial for patients with CHD of all ages in both inpatient and outpatient settings for improvement of patient care and improved resource utilization.…”

Web-Based Motor Intervention to Increase Health-Related Physical Fitness in Children With Congenital Heart Disease: A Study Protocol

“…Indeed, peak oxygen uptake may be the most important prognostic parameter for survival in patients with CHD (19–21) but it is controversial whether that importance already exists in children with CHD. The idea behind is the changing landscape of older patients with CHD that will develop acquired cardiovascular disease, such as hypertension and hyperlipidemia (42, 43). From the perspective of primary prevention, it is therefore more important to shape PA behavior early in life that yield health benefits later in life.…”

FibroSURE and elastography poorly predict the severity of liver fibrosis in Fontan‐associated liver disease

“…Due to advances in medical care and surgical techniques, the population of adults with congenital heart disease (CHD) has been growing exponentially since the 1950s. 1 Survivorship to adulthood is estimated to be greater than 90% of children born with congenital heart disease; with over 1 million adults living in the United States with CHD. [2][3][4] One of the more severe forms of CHD is that of functional single ventricle, including hypoplastic left or right heart syndrome, tricuspid, or pulmonary atresia.…”