Statement on Noncardiac Complications in Adults With CHD

Authors:
Lui GK, Saidi A, Bhatt AB, et al.
Citation:
Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association. Circulation 2017;Oct 9:[Epub ahead of print].

The following are key points to remember from this American Heart Association Scientific Statement on diagnosing and managing noncardiac complications in adults with congenital heart disease (CHD):

  1. Life expectancy and quality of life for those born with CHD have greatly improved over the past 3 decades.
  2. This has resulted in an epidemiological shift and a generation of CHD patients who are at risk of developing chronic multisystem disease in adulthood.
  3. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis.
  4. There is a need for preventive strategies with intervention at an earlier age to mitigate the development of later noncardiac complications.
  5. Imaging of the liver by ultrasound, magnetic resonance imaging, or computed tomography should be considered in patients with abnormal laboratory studies or signs of advanced liver disease. It is reasonable to perform baseline abdominal imaging in patients with Fontan physiology 5 years after Fontan completion regardless of the presence of other abnormal findings.
  6. Pneumococcal polysaccharide (every 5 years) and meningococcal vaccinations are recommended if there is any functional cardiovascular impairment or if there is any associated immune incompetence (e.g., functional asplenia).
  7. Management of hypertension in CHD with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with a mineralocorticoid receptor blocker such as spironolactone or eplerenone may have a cardioprotective benefit.
  8. Disorders of psychosocial and cognitive development are key factors also affecting the quality of life of individuals with CHD.
  9. Exercise testing can objectively measure functional capacity and cardiac reserve, and has an increased role in preoperative evaluation of patients with CHD compared with in the general population.
  10. Adults with CHD often have complex multisystem disease for which both cardiac outcomes and noncardiac complications warrant clinical attention and empirical investigation; an interdisciplinary approach is indicated across the life span of these patients.

Clinical Topics: Anticoagulation Management, Congenital Heart Disease and Pediatric Cardiology, Noninvasive Imaging, Prevention, Congenital Heart Disease, CHD & Pediatrics and Arrhythmias, CHD & Pediatrics and Imaging, CHD & Pediatrics and Prevention, Computed Tomography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging, Hypertension

Keywords: Anemia, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Cognition, Exercise Test, Heart Defects, Congenital, Hypertension, Liver Cirrhosis, Liver Diseases, Lung Diseases, Magnetic Resonance Imaging, Polysaccharides, Primary Prevention, Quality of Life, Receptors, Mineralocorticoid, Renal Insufficiency, Spironolactone, Tomography, X-Ray Computed, Ultrasonography, Vaccination


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