Journal Watch

Access and Delivery of Adult Congenital Heart Disease Care in the United States: Quality-Driven Team-Based Care.

Cardiol Clin. 2020 Aug;38(3):295-304

Authors: Fernandes SM, Marelli A, Hile DM, Daniels CJ

The landscape of congenital heart disease has changed rapidly over the past few decades. The shift from pediatric to adult congenital heart disease care has stretched resources and the ability to provide high-quality access and delivery of care for the more than 1.5 million adults with congenital heart disease in the United States. Meeting the demand for delivering high-quality care requires a team-based approach, with each member highly specialized. This review describes the deficits and deficiencies in providing care for adults with congenital heart disease in the United States and a team-based approach to improving access and delivery of care.

PMID: 32622485 [PubMed - as supplied by publisher]

Aortic Coarctation.

Cardiol Clin. 2020 Aug;38(3):337-351

Authors: Kim YY, Andrade L, Cook SC

Aortic coarctation is a discrete narrowing of the thoracic aorta. In addition to anatomic obstruction, it can be considered an aortopathy with abnormal vascular properties characterized by stiffness and impaired relaxation. There are surgical and transcatheter techniques to address the obstruction but, despite relief, patients with aortic coarctation are at risk for hypertension, aortic complications, and abnormalities with left ventricular performance. This review covers the etiology, pathophysiology, diagnosis, and management of adults with aortic coarctation, with emphasis on multimodality imaging characteristics and lifelong surveillance to identify long-term complications.

PMID: 32622489 [PubMed - as supplied by publisher]

Tetralogy of Fallot.

Cardiol Clin. 2020 Aug;38(3):365-377

Authors: Krieger EV, Valente AM

Repaired tetralogy of Fallot is one of the most common conditions managed by adult congenital heart disease providers. Recent comprehensive review articles and book chapters are devoted to this topic. The purpose of this article is to address several common clinical questions encountered in the management of patients with repaired tetralogy of Fallot. These answers are not intended to supplant Practice Guidelines.

PMID: 32622491 [PubMed - as supplied by publisher]

The Adult Patient with a Fontan.

Cardiol Clin. 2020 Aug;38(3):379-401

Authors: AlZahrani A, Rathod R, Krimly A, Salam Y, AlMarzoog AT, Veldtman GR

The authors summarize the most important anatomic and physiologic substrates of Fontan circulation. Common anatomic substrates include hypoplastic left heart syndrome, tricuspid atresia, double inlet left ventricle, and unbalanced atrioventricular septal defects. After the Fontan operation exercise capacity is limited and the key hemodynamic drivers is limited preload due to a relatively fixed pulmonary vascular resistance. The authors provide contemporary data on survival, morbidity, and need for reintervention. Operative morality is now expected to be less than 1% and 30 year survival approximately 89%. The authors delineate potential therapeutic approaches for the potential late complications.

PMID: 32622492 [PubMed - as supplied by publisher]

Transcatheter Interventions in Adult Congenital Heart Disease.

Cardiol Clin. 2020 Aug;38(3):403-416

Authors: Aboulhosn JA, Hijazi ZM

This article provides a detailed review of the current practices and future directions of transcatheter interventions in adults with congenital heart disease. This includes indications for intervention, risks, and potential complications, as well as a review of available devices and their performance.

PMID: 32622493 [PubMed - as supplied by publisher]

Adults with Congenital Heart Disease and Arrhythmia Management.

Cardiol Clin. 2020 Aug;38(3):417-434

Authors: Moore JP, Khairy P

Arrhythmia management in adult congenital heart disease (ACHD) encompasses a wide range of problems from bradyarrhythmia to tachyarrhythmia, sudden death, and heart failure-related electrical dyssynchrony. Major advances in the understanding of the pathophysiology and treatments of these problems over the past decade have resulted in improved therapeutic strategies and outcomes. This article attempts to define these problems and review contemporary management for the patient with ACHD presenting with cardiac arrhythmia.

PMID: 32622494 [PubMed - as supplied by publisher]

Surgery for Adult Congenital Heart Disease.

Cardiol Clin. 2020 Aug;38(3):435-443

Authors: Geoffrion T, Fuller S

Technical and medical improvements for congenital cardiac disease in children have contributed to an increasing population of patients who survive into adulthood. These patients may be prone to progression of their native palliated disease or suffer from sequelae of their childhood repair that requires repeat surgical intervention. Surgery for adult congenital cardiac disease poses unique challenges and risks.

PMID: 32622495 [PubMed - as supplied by publisher]

Congenital Heart Disease and Pulmonary Hypertension.

Cardiol Clin. 2020 Aug;38(3):445-456

Authors: Constantine A, Dimopoulos K, Opotowsky AR

Pulmonary hypertension (PH) is common in adults with congenital heart disease and carries fundamental implications for management and prognosis. A high index of suspicion, combined with knowledge of the pathogenesis and pathophysiology of PH, is required to achieve a timely, accurate diagnosis, and appropriate classification and treatment. This article provides a guide on how to approach the adult with congenital heart disease and suspected PH of different types, including current management.

PMID: 32622496 [PubMed - as supplied by publisher]

Heart Failure in Adult Congenital Heart Disease.

Cardiol Clin. 2020 Aug;38(3):457-469

Authors: Burchill LJ, Lee MGY, Nguyen VP, Stout KK

As the population of adult congenital heart disease patients ages and grows, so too does the burden of heart failure in this population. Despite the advances in medical and surgical therapies over the last decades, heart failure in adult congenital heart disease remains a formidable complication with high morbidity and mortality. This review focuses on the challenges in determining the true burden and management of heart failure in adult congenital heart disease. There is a particular focus on the need for developing a common language for classifying and reporting heart failure in adult congenital heart disease, the clinical presentation and prognostication of heart failure in adult congenital heart disease, the application of hemodynamic evaluation, and advanced heart failure treatment. A common case study of heart failure in adult congenital heart disease is utilized to illustrate these key concepts.

PMID: 32622497 [PubMed - as supplied by publisher]

Adult Congenital Heart Disease: A Population that Has Come of Age.

Cardiol Clin. 2020 Aug;38(3):xiii

Authors: Daniels CJ

PMID: 32622498 [PubMed - as supplied by publisher]