Training program guidelines, case numbers, and maintenance of certification
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
As patients with congenital heart disease live longer with medical therapy, percutaneous intervention, and surgical treatment, the field of adult congenital heart disease (ACHD) has developed swiftly. In 2015, the first ABIM certifying examination in ACHD was administered, providing formal evaluation of knowledge and training in this subspecialty.22 The examination was offered to candidates who have been previously certified in cardiovascular disease or pediatric cardiology. The formal training pathway requires 24 months of ACHD fellowship training, 18 of these clinical. The practice pathway grants board eligibility to those who have spent at least 40% of their clinical practice time, or 25% of their total post-training professional time, in the clinical practice of ACHD. There are currently eight programs in the United States offering formal ACHD training. Most of these require a pediatric cardiology background; however, it is expected that the number of training spots available to those with adult cardiology and interventional cardiology training will increase dramatically over the next several years.
Congenital heart disease
Nicholas Green, Steven Gaydos, Hutchison Ewan, Edward Nicol in Handbook of Aviation and Space Medicine, 2019
Adult congenital heart disease (ACHD) is uncommon in aircrew; however, with advances in childhood surgery and adult care, an increasing number of individuals with ACHD seek advice with regards to flying, both in the civilian and military sectors. Simple ACHD, especially if repaired in childhood, may be acceptable in aircrew: Conditions that require sustained cardiovascular follow-up, have residual physiological consequence or increase the risk of developing incompatible conditions may preclude individuals from successfully applying to fly.In the military, additional considerations, such as the risk of endocarditis to either native cardiac defects or surgical interventions, may also affect the assessment of suitability for both aircrew candidates and existing aircrew.
Heart disease
Catherine Nelson-Piercy in 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 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.
When Parents Refuse: Resolving Entrenched Disagreements Between Parents and Clinicians in Situations of Uncertainty and Complexity
Published in The American Journal of Bioethics, 2018
Janine Penfield Winters
A second example is determining what is “best” in decision making about surgery for newborns born with hypoplastic left heart syndrome, a condition in which there is only one heart ventricle instead of two. In the past, infants born with this congenital heart defect had a dismal prognosis (Siffel et al. 2015). Treatment has improved in recent decades, but treatment requires a series of high-risk surgeries in the first year of life. With the surgeries, the infant has 50–60% chance of survival to age 1 year (Hirsch et al. 2011; Rogers et al. 2017). After age 1 year, the children usually do well throughout childhood. Thus, the surgical procedures are effective in palliating this serious cardiac anomaly but are also risky (some are left with serious permanent noncardiac disability), grueling (multiple invasive treatments), and expensive (Dean et al. 2011). The long-term outlook is still unknown, but serious sequelae, such as liver disease (Baek et al. 2010, Rychik et al. 2012) often present in early adulthood and there is a high risk of premature death in adulthood (Greutmann et al. 2015; Pundi et al. 2015). So, when are the potential beneficial results of this surgery compelling enough to consider overruling parents who refuse surgery? Doctors disagree (Feudtner 2008; Prsa et al. 2010; Kon 2008; Wernovsky 2008).
An Unguarded Tricuspid Valve Orifice Diagnosed by Autopsy
Published in Fetal and Pediatric Pathology, 2023
Xiaoxue Zhou, Ye Zhang, Yihua He
The family chose termination of the pregnancy. Chromosomal malformation and known congenital heart defect genes were excluded. Exploration of organs such as lungs, liver, gallbladder, and appendix confirmed the normal position and development of internal organs on fetal autopsy. The number of lobes in the lungs were two lobes on the left and three lobes on the right. Marked cardiomegaly was due to the dilated RA on fetal autopsy (Fig. 4). The right ventricle and the left-sided chambers were concordant and of normal size. There was a partial absence of tricuspid septal leaflets and tricuspid septal annulus (Fig. 5). Stenotic pulmonary valve, hypoplasia of the main pulmonary artery and branches were found (Fig. 6). An atrial secundum defect (Fig. 7) with an intact interventricular septum was also present. The final diagnosis on autopsy confirmed UTVO, pulmonary valve stenosis, and secundum atrial septal defect.
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