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Implantation of the Syncardia Total Artificial Heart
Published on: July 18, 2014
Long-term follow-up of operated congenital heart disease
1College of Physicians and Surgeons, Columbia University, New York, New York.
Insights
Long-term follow-up of congenital heart disease surgeries shows excellent prognoses for atrial septal defect (ASD) and ventricular septal defect (VSD) repairs. However, outcomes vary for complex conditions like pulmonary atresia, requiring ongoing monitoring and management.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
- Long-term Patient Outcomes
Background:
- Congenital heart disease (CHD) necessitates surgical intervention, with long-term follow-up crucial for assessing outcomes.
- Understanding the long-term status of patients operated on for common CHD forms is essential for clinical practice.
Purpose of the Study:
- To review the long-term follow-up status of patients who underwent surgery for common types of congenital heart disease.
- To evaluate the prognosis and potential complications in adult survivors of pediatric cardiac surgery.
Main Methods:
- Review of long-term follow-up data for patients with various congenital heart defects.
- Analysis of patient outcomes based on specific diagnoses including large left-to-right shunts, atrioventricular canal defects, right ventricular outflow tract obstruction, and left ventricular outflow obstruction.
Main Results:
- Excellent long-term prognosis for atrial septal defect (ASD) and ventricular septal defect (VSD) with large left-to-right shunts, often leading to normal adulthood.
- Most patients with atrioventricular canal defects remain stable despite residual valve disease.
- Good long-term stability reported for valvular pulmonary stenosis and tetralogy of Fallot, though arrhythmias can occur.
- Guarded prognosis for pulmonary atresia with VSD, with conduit longevity being a major concern (xenografts <10 years).
- Mixed long-term outlook for pulmonary atresia with intact ventricular septum, often resulting in chronic right heart dysfunction.
- Guarded long-term outlook for left ventricular outflow obstruction, with residual aortic stenosis/insufficiency common post-repair.
Conclusions:
- Surgical repair of common congenital heart defects like ASD and VSD generally yields excellent long-term results.
- Complex conditions such as pulmonary atresia present significant long-term challenges, particularly regarding conduit durability and right heart function.
- Patients with residual defects after left ventricular outflow obstruction repair require lifelong monitoring and potential late interventions.
Abstract:
The long-term follow-up status of patients operated upon for the more common forms of congenital heart disease is reviewed. Among patients with large left-to-right shunts the long-term prognosis for those with ASD and VSD is generally excellent. With rare exceptions, these patients can look forward to a normal adulthood. Residual atrioventricular valve disease complicates the long-term course of infants and children operated upon for atrioventricular canal, but nevertheless, most patients have remained stable for many years. Among patients after relief of right ventricular outflow tract obstruction, excellent documentation of long-term stability has been reported for children with valvular pulmonary stenosis, and most patients with tetralogy of Fallot appear to tolerate residual right ventricular outflow stenosis and insufficiency without serious complications. Dysrrhythmias occur, but severe sequelae are rare. The prognosis for survivors of pulmonary atresia with VSD is more guarded. Conduit longevity appears to be the most important concern, and long-term studies indicate that xenografts rarely last beyond a decade. The modern types of homografts cannot yet be evaluated on a long-term basis. For patients with pulmonary atresia and intact ventricular septum, there are a number of long-term survivors, but most have chronic right heart dysfunction with only a rare, outstanding result. The long-term outlook for patients with left ventricular outflow obstruction is guarded. Most patients after repair of aortic stenosis have residual aortic stenosis and/or insufficiency. Postaortic valvotomy adults tend to be symptom-free, despite residual disease, but almost certainly late management will be required.(ABSTRACT TRUNCATED AT 250 WORDS)
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