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[Congenital cardiopathies in adults. 179 cases]
Insights
Adults with congenital heart disease (CHD) often have atrial septal defects (ASD) or ventricular septal defects (VSD). Early surgical repair is recommended for most CHDs to prevent complications and improve long-term survival.
Area of Science:
- Cardiology
- Adult Congenital Heart Disease
- Pediatric Cardiology
Context:
- Congenital heart disease (CHD) in adults constitutes a significant portion of all CHD cases.
- Atrial septal defect (ASD) is the most prevalent type, particularly in individuals over 40.
- Ventricular septal defect (VSD) is also common, with a tendency for spontaneous closure in some cases.
Purpose:
- To review the presentation and management of congenital heart disease in adult patients.
- To emphasize the importance of timely surgical intervention for various forms of CHD.
- To highlight specific considerations for ASD, VSD, coarctation of the aorta, and Tetralogy of Fallot in adulthood.
Summary:
- Atrial septal defects (ASDs) are the most common CHD in adults, often requiring repair unless severe pulmonary hypertension is present.
- Ventricular septal defects (VSDs) are frequent, and spontaneous closure can occur even in adulthood.
- Coarctation of the aorta necessitates early surgical correction to mitigate long-term hypertension risks.
- Eisenmenger's syndrome, a complication of uncorrected VSD or large ASDs, can be well-tolerated in adults.
- Tetralogy of Fallot survival beyond 20 years without surgery is rare, underscoring the need for early complete repair.
Impact:
- Advocates for the systematic repair of most adult congenital heart diseases, excluding minor forms or those with no current surgical solution.
- Underscores the critical role of early surgical intervention in preventing long-term complications and improving survival rates for pediatric and adult CHD patients.
- Provides guidance on managing specific congenital heart conditions presenting in adulthood, informing clinical practice and patient care strategies.
Abstract:
Congenital heart disease in the adult represents less than 25 p. 100 of all congenital heart diseases; 179 out of 800 cases in the authors' experience. Atrial septal defect (ASD) is by far the most common (44 cases) especially in adults over 40 years of age. Practically all large ASD develop complications and systematic repair is recommended in all age groups except in forms with severe pulmonary hypertension and high pulmonary arteriolar resistance. Ventricular septal defect (VSD) is almost as common. They are usually small and only rarely present after 40 years of age, suggesting that spontaneous closure may occur even after 20 years of age. Coarctation of the aorta should be operated on before adulthood as persistant hypertension becomes more common in patients operated later. Eisenmenger's syndrome, the inevitable conclusion of VSD with severe hypertension not operated during childhood, or of some large ASDs in adults is often well tolerated and may survive until an advanced age. Survival of Fallot's tetralogy is very rare after 20 years without surgery; complete repair should therefore be performed early despite its drawbacks. Thus, unoperated congenital heart diseases should no longer be observed in adults excepting minor forms which do not justify the operative risks, and complicated forms for which no surgical cure is yet available.