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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
All patients diagnosed with congenital heart disease should be referred to a suitable cardiologist who specializes in adult congenital heart disease (patients over 18 years) or a paediatric cardiologist (under 18 years).
Heart disease
Published in Catherine Nelson-Piercy, Handbook of Obstetric Medicine, 2020
This is one of the commonest conditions encountered in adult congenital heart disease clinics. The vast majority of women encountered in pregnancy will have undergone surgical correction. If unoperated, those without pulmonary vascular disease may negotiate pregnancy successfully. There are two main concerns: Paradoxical embolism through the right-to-left shunt causing cerebrovascular accidentsEffects of cyanosis and maternal hypoxaemia on the fetus – Oxygen saturation falls markedly on exercise– Fetal growth restriction– Increased risk of miscarriage– Increased risk of spontaneous and iatrogenic prematurity
Exercise testing patients with restrictive lung abnormalities
Published in Robert B. Schoene, H. Thomas Robertson, Making Sense of Exercise Testing, 2018
Robert B. Schoene, H. Thomas Robertson
Adults with surgically corrected congenital heart disease usually required thoracic surgery interventions in infancy, creating a mild-to-moderate restrictive pulmonary abnormality that persists into adulthood. However, none of those individuals show an exercise limitation suggestive of ventilatory limitation. To some extent, this lack of a ventilatory impairment is attributable to limitations of the cardiac surgical corrections, so that maximal exercise ventilation is lower because of a lower maximal cardiac output. However, even for the adult congenital heart disease patients who have normal maximal oxygen uptakes (as can be seen with some patients with corrected Tetralogy of Fallot), their exercise performance is not limited by restriction of ventilation.
Comparison of Short-Term Quality of Life between Percutaneous Device Closure and Surgical Repair via Median Sternotomy for Atrial Septal Defect in Adult Patients
Published in Journal of Investigative Surgery, 2021
Kai-Peng Sun, Ning Xu, Shu-Ting Huang, Liang-Wan Chen, Hua Cao, Qiang Chen
.In the study by Eren and colleagues, patients with ASD who underwent percutaneous device closure experienced a quality of life as high as that of healthy people [21]. In our longitudinal comparison, patients’ quality of life improved after percutaneous device closure or surgical repair, which is consistent with the results Cohen et al observed in elderly patients [22]. Our finding is also similar to Loup O’s finding of improved quality of life in adult congenital heart disease patients after radical treatment [23]. This might be because the patient’s hemodynamic abnormalities were corrected and their physical limitations were ameliorated by the treatment. At the same time, patients may experience better support in some social domains, such as through social insurance, employment, education, etc. In addition, with regard to psychological aspects, after experiencing disease events, people’s feelings and pursuit of goals often change, and their worries and anxiety about some events are not as serious as they were before. This was reflected in the improvement in the HADS score in our study. This can also be verified by the improvement in various emotional dimensions on the SF-36.
Exercise training and cardiac rehabilitation in cardiovascular disease
Published in Expert Review of Cardiovascular Therapy, 2019
Sergey Kachur, Carl J. Lavie, Rebecca Morera, Cemal Ozemek, Richard V. Milani
Indications for referral to CR are broad and can vary across countries, but the general consensus is that a patient qualifies if they have suffered an acute MI, coronary artery bypass graft surgery (CABG), stable angina pectoris, percutaneous coronary intervention (PCI), heart valve replacement or repair, or heart transplantation [57]. HF patients were previously excluded from this group due to concerns about associated acute decompensation; however, recent data have shown benefits in these populations prompting changes in practice and guidelines [58]. Adult congenital heart disease (ACHD) patients are another group of at-risk individuals that were historically regarded to have limited benefits from ET due to high perceived risk of adverse events, and although there is favorable risk data in patients undergoing ET, this is not a group currently approved for CR in the US (though other countries such as Canada allow participation of ACHD patients) [59,60]. Contraindications include ventricular arrhythmias, unstable angina, severe pulmonary arterial HTN, severe aortic stenosis, and musculoskeletal conditions that prevent ET.
The Key Elements That are Fundamental for Initiating a Structural Heart Program
Published in Structural Heart, 2018
Given the relatively recent emergence of structural heart disease as an entity within cardiology, many institutions are in the process of initiating structural heart disease programs. These programs have been oriented primarily toward interventional procedures thus far, but often include clinics devoted specifically to valvular heart disorders, adult congenital heart disease and others. Very often fellows who are finishing specialized training in structural heart disease are recruited to initiate these new programs. Therefore, these newly minted structural specialists must not only insure high technical quality of interventional procedures, but also lead the administrative task of developing the entire program. Based upon my experience, there are a number of steps that are critical in successfully developing an effective structural heart disease program.