Current diagnosis and management of late complications in adult congenital heart disease

摘要

Improvements in quality and level of care in pediatric and adult cardiology, cardiovascular surgery, intensive care as well as improvements in pharmacotherapy resulted in the survival and increased life expectancy of congenital heart disease (CHD) patients to adulthood. At present, in the industrialized world, up to 97% of children born with CHD reach adulthood. Surgical treatment made survival to adulthood possible for CHD patients; however, these operations are seldom curative. Postoperative residua, sequellae, new onset long-term surgical complications and cardiac and non-cardiac comorbidities adversely impair the long-term course of CHDs and, therefore, require regular medical follow-up by adult congenital heart disease (ACHD) specialists or cardiologists experienced in the care of these patients. Particularly patients with moderate to complex lesions, both unoperated and postoperative, require lifelong surveillance. Because of this, a number of specialized ACHD centers have emerged in the past 3-4 decades in Europe and North America, followed by the Asia-Pacific region, to respond to this need. This evolving field has been developing day by day, and in 2015, examination for board certification as one of the internal medicine subspecialties was initiated in the North America and possibly the trend developed internationally in Europe and Japan. In Germany, there is a special situation, since certification for ACHD specialists (pediatric cardiologists or cardiologists in practice, clinics and centers) has been in place for several years by national medical societies.