Congenital heart disease (CHD) is the most common birth defect in the United States, occurring in one of every 110 births. Due to medical breakthroughs and progress in treatment, patients with CHD are reaching adulthood and living longer. Currently, there are more than one million adults in the United States living with this disease, and this number continues to rise by approximately 5 percent each year. At least 10 percent of all congenital heart defects are first detected in adulthood.

Adolescents and adults with CHD face unique challenges; the most common problem among adults is arrhythmia. In addition, research has shown that the risk of sudden cardiac death for patients surviving operation is 25 to 100 times greater in an adult with CHD compared with a typical adult. 1 Therefore, an aggressive approach to evaluation and treatment is necessary. This requires a coordinated team approach that includes an initial evaluation, explanation of therapeutic options, innovative surgical and transcatheter therapies and consultative follow-up.

The 2008 American College of Cardiology/American Heart Association Task Force on Practice Guidelines recommend that all patients with adult congenital heart disease (ACHD) have a primary physician and that they be evaluated by a cardiologist with advanced training and expertise in ACHD. Frequency of follow-up is based on the patient’s condition. In addition, patients who require interventional and/or surgical cardiovascular procedures are best served at centers with a specialized multidisciplinary adult congenital heart center. 2

AHI’s Congenital Heart Disease Center, directed by Dimitrios Avgerinos, MD, and Kostas Charitakis, MD, uses a multidisciplinary team approach to deal with issues specific to adolescent and adult patients with congenital heart disease (CHD). The team includes surgeons and cardiologists who specialize in both pediatric and adult CHD, anesthesiologists, internists, geneticists, dentists, obstetricians and gynecologists, psychiatrists, radiologists, cardiac rehabilitation, and physical and occupational therapists. AHI’s Adult Congenital Heart Disease Center combines cutting-edge technology with compassion and a family-centered approach to congenital heart care.

The most common adult congenital cardiac abnormalities are:

Iatrogenic: after surgical repair of a congenital heart disease at an earlier stage, usually in the childhood (pulmonary valve insufficiency after repair of tetralogy of Fallot, pulmonary artery stenosis, residual ventricular septal defects, and others)

  • Abnormalities of valve structures such as bicuspid aortic valve, valve prolapse, pulmonary valve stenosis, Ebstein anomaly involving the tricuspid valve and others.
  • Atrial septal defect (ASD), Patent Foramen Ovale (PFO)
  • Ventricular septal defect (VSD)
  • Patent ductus arteriosus (PDA)
  • Abnormal pulmonary veins
  • Abnormalities of coronary arteries
  • Coarctation of the aorta
  • Pulmonary artery stenosis
  • Tetralogy of Fallot (TOF)
  • Transfer of the great arteries (TGA)
  • Pulmonary Hypertension

Surgical treatment of adult congenital heart disease

The surgical treatment of congenital heart disease involves repair techniques which use tissue from the patient’s own body (pericardium) or advanced synthetic materials such as Gore-Tex. It is preferable to repair the affected valve and to replace it only when necessary using prosthetic valves (mechanical or biological).

Percutaneous techniques to deal with adult congenital heart disease

For some patients with congenital heart disease, their heart defect can be treated without surgery using percutaneous techniques. Specially trained interventional cardiologists can place intra-cardiac ‘devices’ in the heart by inserting them through a tube in the artery or vein of the patient’s leg. Depending upon the underlying problem, the devices can close defects (holes) in the heart, enabling narrowed valves to be opened up and in some cases allow prosthetic valves to be implanted. In cases of certain atrial septal defects (secondary or secundum) and when there are no other co-existent heart defects, percutaneous closure may be the preferred method of treatment.

adult congenital

 

At AHI, we have extensive experience with surgical and percutaneous treatment of adult congenital heart diseases with great results.

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Participation in the Pulse and Cardioelectrics Conference, July 2014

Feb 06/02/2014

Dr. Avgerinos participated and spoke at the Pulse and Cardioelectrics Conference, which took place from July 13-15 in Hersonissos, Krete. His speech was about the modern methods for treating aortic …

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