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Congenital heart disease
Published in Clive Handler, Gerry Coghlan, Nick Brown, Management of Cardiac Problems in Primary Care, 2018
Clive Handler, Gerry Coghlan, Nick Brown
Some patients are appropriately managed with care shared between a paediatric cardiologist and the GP. The management and follow-up of patients with complex congenital heart disease demand the skills and experience of regional paediatric cardiological centres and grown-up congenital heart disease units. There are also centres that specialise in the care of patients over 16 years of age, an increasingly large group known as GrownUp Congenital Heart Disease (GUCH). These are regional centres, staffed by multi-disciplinary teams, which have facilities for invasive diagnosis, intervention and cardiac surgery, and some centres provide heart transplantation.
The effect of exercise training in symptomatic patients with grown-up congenital heart disease: a review
Published in Expert Review of Cardiovascular Therapy, 2018
Jean-Luc Q. Hooglugt, Alexandra C. van Dissel, Ilja M. Blok, Ferdinand H. de Haan, Harald T. Jørstad, Berto J. Bouma, Barbara J. M. Mulder, Michiel M. Winter
The number of grown-up congenital heart disease (GUCH) patients is steadily increasing, with even those with severe heart defects now reaching adulthood. Unfortunately, the large majority of those patients suffer from late sequelae, with congestive heart failure being the main contributor of cardiac morbidity and premature death.In theory, patients with heart failure due to congenital heart disease could equally benefit from exercise training, as patients with acquired heart failure. One would expect exercise training to result in equal physiological changes, and in similar reduction of risk factors.Patients with acquired heart failure can safely perform exercise training, with beneficial effects on (cardiac) morbidity and mortality. Data on exercise training in acquired heart disease are much more prevalent, as a recent Cochrane review included more than 4,500 heart failure patients in their analyses. For patients with acquired heart disease, these data have resulted in cardiac rehabilitation programs with a key role for exercise trainingData of exercise training in symptomatic GUCH patients are scarce. In the past this has led cardiologists to be reluctant in their advice on exercise training in symptomatic GUCH patients, with possible counterproductive results. Fortunately, there is a trend toward a more supportive attitude toward appropriate exercise training, which seems justified.There is a limited evidence supporting safety and benefit from exercise training in symptomatic GUCH patients, which is, however, insufficient to draw definite conclusions. A well-designed, randomized controlled trial that includes symptomatic GUCH patients with a wide variety of congenital cardiac anomalies evaluating long-term, patient tailored exercise training is warranted to fill this hiatus in current knowledge and produce concise and practical recommendations.