The addition of acquired heart disease may lead to symptoms such as exercise intolerance with significant disability in a previously asymptomatic patient. It can become more complicated to care for middle-aged and older patients with residual hemodynamic abnormalities despite the success of their earlier operative intervention when acquired heart disease intervenes. There are people who are diagnosed for the first time in adulthood, as well as those with prior palliative repair and its consequences, new sequelae years to decades after childhood surgical repair, or residual lesions with delayed presentation. We emphasize that this is the beginning of a discussion regarding this rapidly growing population, and continued research aimed at the progression of disease and complications reviewed here is necessary to advance the field of ACHD with the scientific rigor it deserves.ĪCHD encompass a broad range of presentations.
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Much of the information we provide is from scientific research combined with clinical experience from longitudinal care. This population with CHD is unique and distinct from both the pediatric and young adult populations with CHD. It is meant to be complementary to the 2008 American College of Cardiology (ACC)/AHA guidelines for ACHD and orient the reader to the natural history, ramifications of childhood repair, and late initial diagnosis of CHD in the older adult. This American Heart Association (AHA) scientific statement will focus on the older adult (>40 years old) with CHD. Despite the advances in this field, death rates in the population from 20 to >70 years of age may be twice to 7 times higher for the ACHD population than for their peers. The predictable natural progression of CHD entities and sequelae of previous interventions must now be treated in the setting of late complications, acquired cardiac disease, multiorgan effects of lifelong processes, and the unrelenting process of aging. This improved longevity is leading to increased use of the medical system for both routine and episodic care, and caregivers need to be prepared to diagnose, follow up, and treat the older adult with congenital heart disease (CHD). The population of adults with congenital heart disease (ACHD) has increased dramatically over the past few decades, with many people who are now middle-aged and some in the geriatric age range.
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Customer Service and Ordering Information.Journal of the American Heart Association (JAHA).Stroke: Vascular and Interventional Neurology.Circ: Cardiovascular Quality & Outcomes.Arteriosclerosis, Thrombosis, and Vascular Biology (ATVB).