Perspectives in the management of congenital heart defects in adult patients

Abstract

Due to improving results in congenital heart surgery, the number of adult patients with congenital heart defect is increasing. The question is: what kind of problems can be managed in this patient-group? The authors review the different problems of management of congenital heart defects in adults based on national and international literature data. Simple defects recognised in adults, postoperative residual problems, changing of small grafts and valves, correction of primary or operated coarctation aortae can be usually managed without problems. A very close follow-up is necessary to establish the correct period for heart transplantation in patients with transposition of great arteries with Senning/Mustard operation, and univentricular heart corrected with "Fontan-circulation" type surgical procedure. The authors conclude that although the number of patients increases, only a few congenital heart diseases may cause problems. It seems important (1) to monitor asymptomatic patient who underwent operation (Fallot-IV, Ross procedure, etc.), (2) follow up regularly patients who underwent Senning/Mustard procedure (magnetic resonance imaging, echocardiography, brain natriuretic peptide measurement), (3) define the proper period of preparation for heart transplantation of patients with a univentricular heart, with special attention to the possibility of multiorgan (lung, liver, etc.) failure. Due to the improvement of foetal diagnosis of congenital heart defects, the number of patients with complex congenital heart defects is decreasing. The standard management of these patients could be primary heart transplantation in infancy.

A mitralis billentyű sebészete atrioventricularis septumdefektusban

“…), minden esetben kiegészítve ringbeültetéssel. Reoperáció esetén plasztikai megoldások után műbillentyűbeültetés, műbillentyű esetén annak cseréje szükséges [18][19][20][21][22][23][24]. Napjainkban kezdenek elterjedni a katéteres intervenciós megoldások, ballonfeltágítással transzkatéteres mitralisbillentyű-beültetés, transseptalis vagy hibrid megoldással [25][26][27][28][29][30].…”

Advances in the diagnostics and management of congenital heart diseases

“…Regarding these facts, treatment of TGA is to perform a palliative operation to keep communication between the two circulations in early infancy, then following weight gain to restore circulation via reconstructive procedures (5,6). From the 1960s till 1990s, atrial reconstructive switch surgery based on the creation of a flap was the widespread methodology.…”