Congenital Heart Disease in the Older Adult

Bhatt, Ami B.; Foster, Elyse; Kuehl, Karen S.; Alpert, Joseph S.; Brabeck, Stephen; Crumb, Stephen R.; Davidson, William R.; Earing, Michael G.; Ghoshhajra, Brian B.; Karamlou, Tara; Mital, Seema; Ting, Jennifer; Tseng, Zian H.

doi:10.1161/cir.0000000000000204

Cited by 196 publications

(94 citation statements)

References 447 publications

(500 reference statements)

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“…These findings emphasise the importance of aggressive prevention of obesity in adult patients with congenital heart disease. Our results are consistent with the recently published American Heart Association scientific statement on Congenital Heart Disease in the Older Adult, which stressed the role of ideal body weight attainment in this population [27].…”

Section: Discussionsupporting

confidence: 92%

Assessment of systemic right ventricular function in adult overweight and obese patients with congenitally corrected transposition of the great arteries

Kowalik¹,

Klisiewicz²,

Biernacka³

et al. 2017

Kardiol Pol

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A b s t r a c t Background:In congenitally corrected transposition of the great arteries the right ventricle (RV) supports systemic circulation, and patients are prone to develop heart failure over time. Chronic volume overload secondary to obesity may contribute to premature dysfunction of the systemic RV. Aim:The aim of our study was to assess the systemic RV function in overweight/obese adult patients with congenitally corrected transposition of the great arteries. Methods:Transthoracic echocardiographic studies and laboratory testing (N-terminal pro-B-type natriuretic peptide [NT-proBNP] assessment) were performed in patients with congenitally corrected transposition, who were scheduled for a routine examination, and the body mass index was calculated for each patient. Results:We studied 56 adults (31 men; mean age 33.9 years); 22 of whom were overweight (body mass index [BMI] of 25-29.9 kg/m 2 ) or obese (BMI of 30 kg/m 2 or more), and 34 of whom were normal weight (BMI below 25 kg/m 2 ). Age, gender, heart rate, and blood pressure were similar in both groups. The mean NT-proBNP levels were not significantly different. On echocardiography, the overweight/obese patients had a decreased systemic RV fractional area change (0.38) compared to normal weight patients (0.43); p = 0.02. Moreover, a significant reduction in the global longitudinal strain in the overweight/obese group was observed (-15.3% vs. -18.3%; p = 0.01).Conclusions: Overweight/obesity in adult patients with congenitally corrected transposition of the great arteries is associated with impaired systemic RV function.

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Section: Discussionsupporting

confidence: 92%

Assessment of systemic right ventricular function in adult overweight and obese patients with congenitally corrected transposition of the great arteries

Kowalik¹,

Klisiewicz²,

Biernacka³

et al. 2017

Kardiol Pol

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“…Data on cognitive function in ACHD are limited and mixed [19], but a predilection toward neurologic abnormalities in ACHD can be expected given the high frequency of neurodevelopmental abnormalities in pediatric CHD [20]. The prevalence of neurologic abnormalities among school-age CHD patients ranges from 20% in total anomalous pulmonary venous connection and isolated atrioventricular septal defects, to as high as 70% in TGA and hypoplastic left heart syndrome [21].…”

Section: Neurodevelopmental Issuesmentioning

confidence: 99%

“…In general, the prevalence and severity of neurodevelopmental impairment increase with lesion complexity [22]. Acquired brain injury has been associated with cardiopulmonary bypass and circulatory arrest during CHD surgery [20]. Developmental abnormalities can also result from disturbed fetal and/or postnatal cerebral blood flow (seen in hypoplastic left heart syndrome and TGA), hypoxemia (CCHD), failure to thrive, arrhythmias, seizures, or hypotension (often in relation to procedures) [23].…”

Section: Neurodevelopmental Issuesmentioning

confidence: 99%

“…Finally, children undergoing cardiac surgery have high rates of post-traumatic stress disorder, though it remains unknown whether this carries over to adult survivors [29]. ACHD patients should be screened for depression and anxiety, and guidelines recommend assessment of psychosocial needs as part of routine care, with mental health providers included in the care team [20].…”

Section: Neuropsychiatricmentioning

confidence: 99%

“…Pregnancy, labor, and delivery impose significant physiologic and psychosocial challenges on CHD patients, but most can have successful courses when managed appropriately [20]. A detailed description of the management of pregnancy in ACHD is beyond the scope of this review; interested readers are directed instead to Greutmann and Pieper [80] for an excellent discussion.…”

Section: Pregnancymentioning

confidence: 99%

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Extra-cardiac manifestations of adult congenital heart disease

Gaeta

Ward

Krasuski

2016

Trends in Cardiovascular Medicine

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a b s t r a c tAdvancement in correction or palliation of congenital cardiac lesions has greatly improved the lifespan of congenital heart disease patients, resulting in a rapidly growing adult congenital heart disease (ACHD) population. As this group has increased in number and age, emerging science has highlighted the systemic nature of ACHD. Providers caring for these patients are tasked with long-term management of multiple neurologic, pulmonary, hepatic, renal, and endocrine manifestations that arise as syndromic associations with congenital heart defects or as sequelae of primary structural or hemodynamic abnormalities. In this review, we outline the current understanding and recent research into these extra-cardiac manifestations.Key words: Cardiovascular disease, Adult congenital heart disease, Pulmonary hypertension. Advances in the diagnosis and management of congenital heart disease (CHD) over the past several decades have greatly improved longevity and quality of life in the CHD population. Palliative or corrective interventions are now available for nearly every type of congenital cardiac lesion, and approximately 90% of affected children now survive to adulthood [1]. Adults with CHD (ACHD) already outnumber pediatric CHD patients, and this population is expected to grow by 5% per year [1,2]. Strikingly, the median age of severe CHD patients has increased from 11 years in 1985 to 25 years in 2010 [3]. Continued improvement in CHD interventions means that new (and more complex) populations will likely reach adulthood in the coming years.Practitioners who take care of adults with CHD are often charged with the delivery or coordination of comprehensive care for these complex patients, including the management of manifestations and complications that arise later in life. ACHD has many extra-cardiac effects, both as syndromic associations with congenital heart defects, or more commonly, as sequelae of primary structural or hemodynamic abnormalities. The role of genetic predilection remains undefined for nearly all extra-cardiac complications, though their incidence has clearly risen over the past decades. Indeed, more than a third of hospital admissions for ACHD patients are now for noncardiovascular reasons [4]. Optimal care of ACHD patients, therefore, mandates a thorough understanding of its multiorgan system manifestations. Herein, we will review current understanding of the most common manifestations of ACHD organized by the affected organ systems. Neurologic/neuropsychiatric Cerebrovascular complicationsA recent study quantified the strikingly high rates of stroke in ACHD [5]. Among nearly 30,000 ACHD patients, 8.9% of men http://dx

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Irregular Narrow Complex Tachycardia in the Setting of Congenital Heart Disease

Oesterle

Tseng

2018

JAMA Intern Med

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A man in his 20s with complex congenital heart disease (CHD) that included D-transposition of the great arteries, single ventricle physiology (upstairs-downstairs configuration of the ventricles with a large ventricular septal defect with outflow extension), and Fontan circulation was admitted to a hospital with lightheadedness and syncope that occurred while he was walking. He had a heart rate of 183 beats Clinical Review & Education Challenges in Clinical Electrocardiography

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Congenital Heart Disease in the Older Adult

Cited by 196 publications

References 447 publications

Assessment of systemic right ventricular function in adult overweight and obese patients with congenitally corrected transposition of the great arteries

Assessment of systemic right ventricular function in adult overweight and obese patients with congenitally corrected transposition of the great arteries

Extra-cardiac manifestations of adult congenital heart disease

Irregular Narrow Complex Tachycardia in the Setting of Congenital Heart Disease

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