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Cardiovasc Diagn Ther. 2018 Dec;8(6):705-715. doi: 10.21037/cdt.2018.10.15.

Improving medical care and prevention in adults with congenital heart disease-reflections on a global problem-part I: development of congenital cardiology, epidemiology, clinical aspects, heart failure, cardiac arrhythmia.

Author information

1
Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich, Technical University Munich, Munich, Germany.
2
Department of Cardiology, Cardiovascular Center, St Luke's International Hospital, Tokyo, Japan.
3
Dokuz Eylul University Hospital air Esref Cad, Izmir, Turkey.
4
Toronto Congenital Cardiac Centre for Adults, Peter Munk Cardiac Centre, University Health Network, Toronto General Hospital, and University of Toronto, Toronto, Ontario, Canada.
5
Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, USA.
6
Central Clinical School Heart Research Institute C39 - Royal Prince Alfred Hospital, The University of Sydney, NSW 2006, Australia.
7
Institute of General Practice and Family Medicine, University Hospital of Ludwig-Maximilians-University Munich, Munich, Germany.
8
Chair of Behavioral Epidemiology, Institute for Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany.
9
Preventive Pediatrics, Technical University Munich, Munich, Germany.
10
Cardiological Clinic Solingen, Solingen, Germany.
11
Department of Cardiac Surgery, University of Erlangen, Erlangen, Germany.
12
Department of Cardiology, University of Erlangen, Erlangen, Germany.
13
Clinic for Thorax-, Heart- and Vessel Surgery, German Heart Competence Center, Tübingen, Germany.
14
Medical Clinic I, University Mannheim, Mannheim, Germany.
15
University Heart Center Hamburg, University Clinic Hamburg-Eppendorf, Hamburg, Germany.
16
Clinic for Pediatric Cardiology und Intensive medicine, Medical School Hannover, Hannover, Germany.
17
Institute for Clinical Pharmacology, Medical Faculty, Technical University Carl Gustav Carus, Dresden, Germany.
18
Competence Network Congenital Heart Defects, Berlin, Germany.

Abstract

Today most patients with congenital heart defects (CHD) survive into adulthood. Unfortunately, despite relevant residua and sequels, follow-up care of adults with congenital heart disease (ACHD) is not performed in specialized and/or certified physicians or centres. Major problems in the long-term course encompass heart failure, cardiac arrhythmias, heart valve disorders, pulmonary vascular disease, infective endocarditis, aortopathy and non-cardiac comorbidities. Many of them manifest themselves differently from acquired heart disease and therapy regimens from general cardiology cannot be transferred directly to CHD. It should be noted that even simple, postoperative heart defects that were until recently considered to be harmless can lead to problems with age, a fact that had not been expected so far. The treatment of ACHD has many special features and requires special expertise. Thereby, it is important that treatment regimens from acquired heart disease are not necessarily transmitted to CHD. While primary care physicians have the important and responsible task to set the course for adequate diagnosis and treatment early and to refer patients to appropriate care in specialized ACHD-facilities, they should actively encourage ACHD to pursue follow-up care in specialized facilities who can provide responsible and advanced advice. This medical update emphasizes the current data on epidemiology, heart failure and cardiac arrhythmia in ACHD.

KEYWORDS:

Congenital heart defect (CHD); endocarditis; heart failure; primary health care; pulmonary hypertension

Conflict of interest statement

Conflicts of Interest: R Neidenbach received research grants (“Unrestricted educational grant”) from Actelion Pharmaceuticals Deutschland GmbH and from the German Heart Foundation (“Deutsche Herzstiftung e.V.) and the patient organization “Herzkind e. V.”. H Kaemmerer received fees and/or travel expenses for consulting activities and/or lectures from the following companies within the last 3 years: Actelion, Pfizer, Bayer-Healthcare, Bristol-Myers Squibb. D Pittrow has received speaker fees or honoraria for consultations from Actelion, Bayer, Genzyme, Boehringer Ingelheim, Novartis, MSD, and Pfizer. E Oechslin currently holds the “Bitove Family Professorship for Adult Congenital Heart Disease”. Other authors have no conflicts of interest to declare.

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