CHAPTER 10 Congenital Heart Disease in Children and Adults
This chapter describes the enormous progress that has been made in the diagnosis, investigation, and management of patients with congenital cardiac malformations, who are seen with increasing frequency in adult cardiac practice. Management of these often challenging patients has become an important ‘subspecialty’ of adult cardiology, but appropriate systems for care delivery have not yet been developed in most countries. Nomenclature, aetiology, and incidence are considered as well as common presenting features. Investigative strategies are then reviewed as these have evolved rapidly in the last two decades, with a shift from invasive to non-invasive protocols involving echocardiography, magnetic resonance imaging and computed tomography. Modern treatment approaches have also developed considerably and now involve both surgery and interventional catheterization, often as part of a ‘hybrid’ lifetime strategy for management of the congenital malformation.In the second half of the chapter, the most important congenital cardiac malformations are described individually, with discussion on morphology, pathophysiology, early presentation, investigation, natural history, management, and late outcome. The information on these individual lesions should be invaluable to the practising cardiologist involved in the care of patients with congenital heart disease (CHD), and, in particular, inform on when referral to a specialist centre is appropriate. It is essential for those involved in the care of adults with CHD to understand the childhood phase of the various malformations. Similarly, paediatric cardiologists and allied professionals can only improve management if they are familiar with long-term results of the various treatment strategies undertaken in childhood.
Chapter 28)
