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Chapter 30 Congenital Heart Disease in Adults

 

This is damage walled vessels with prevalent damaging arteries medium and small size on the bases immunity. Formation is obliteration vessels, thromboses, according transgression blood circulation.

Etiology: to used drugs – sulphanidamides, antibiotics, antituberculous remedy. Viruses – hepatitis B, herpes.

Clinically:

1. temperature rise not keep the by antibiotics, lose one’s weight, commonly intoxication.

2. skin syndromes, eruptions erythematous, hemorrhagic, nacreous. Nodes which palpation into the hypoderms by longitudinal vessels.

3. skeleton-muscles system: muscles of pain, atrophy.

4. cardiovascular symptoms: stenocarda, infarction, heart block.

5. lungs: pneumonia, breathing insufficient.

6. digestive: pain in abdomen, ulcers.

7. treatment: glucocorticoid, cytostatic, antiagregatic, NSID, aminohynolinic, efferent drug.

 

 

 

 

Chapter 30 Congenital Heart Disease in Adults

JOSEPH K. PERLOFF

SURVIVAL PATTERNS

Unoperated Patients

Common Defects in Which Unoperated Adult Survival is Expected

Uncommon Defects in Which UnoperatedAdult Survival is Expected

Common Defects in Which Unoperated Adult Survival is Exceptional

Late Survival After Cardiac Surgery or Interventional Catheterization

MEDICAL MANAGEMENT OF ADULTCONGENITAL HEART DISEASE

Cyanotic

Infective Endocarditis: Risks and Prophylaxis

Pregnancy and Congenital Heart Disease: The Mother and the Fetus

Medical Management of the PregnantWoman with Congenital Heart Disease

Medical Management of the Fetus

Exercise Before and After Surgery or Interventional Catheterization

Surgical Considerations

Cardiac Catheterization as a Therapeutic Intervention

Noncardiac Surgery in Adults with Congenital Heart Disease

Postoperative Residua and Sequelae

REFERENCES

 

Advances in diagnostic techniques and in the surgical and medical management of infants and children with congenital malformations of the heart and circulation have had a major impact upon longevity.1–3 The number of older patients with congenital heart disease is steadily increasing, and the trend promises to continue. Congenital heart disease in adults has emerged as a special area of cardiovascular interest4 that includes patients who have never undergone cardiac surgery, those who have undergone cardiac surgery and require no further operation, those who have had palliation with or without anticipation of reparative surgery, and those whose condition is inoperable apart from organ transplantation. This chapter begins with a brief historical perspective and then focuses upon the multidisciplinary facilities for comprehensive care, survival patterns (without operation and postoperative), medical considerations, surgical considerations, and postoperative residua and sequelae.2

HISTORICAL PERSPECTIVES

Congenital heart disease is, by definition, present at birth (con, together; genitus, born), but survival patterns vary widely.2,5 In 1888, Etienne-Louis Arthur Fallot wrote, “We have seen from our observations that cyanosis, especially in the adult, is the result of a small number of cardiac malformations well determined.”6 Fallot referred to the tetralogy that still bears his name as one of the most familiar eponyms in cardiovascular medicine.



In the first half of the twentieth century, the untiring work of Maude Abbott culminated in her remarkable Atlas of Congenital Heart Disease, which was based upon 1000 pathology specimens personally studied.7 The atlas was not only a landmark in the classification of congenital malformations of the heart but also provided invaluable information on survival patterns before the advent of cardiac surgery. The seminal contributions of Gross, Blalock, and Crafoord appreciably modified those survival patterns, and the sense of despair that had surrounded congenital cardiac anomalies—those “hopeless futilities”—began to dissipate.

In 1939, Robert Gross, a pediatric surgeon in Boston, ligated a patent ductus arteriosus in a 71/2-year-old girl.8 A few years later, Helen Brooke Taussig, a pediatric cardiologist in Baltimore, conceived the idea of “creating” a patent ductus in cyanotic children suffering from deficient pulmonary blood flow, and in 1945, Alfred Blalock, a vascular surgeon at Johns Hopkins Hospital, implemented Taussig’s idea by suturing the end of a subclavian artery to the side of a pulmonary artery in a patient with Fallot’s tetralogy, thus establishing the Blalock-Taussig anastomosis.9 Before this operation, “. . . a blue baby with a malformed heart was considered beyond the reach of surgical aid.” In the early 1940’s, Clarence Crafoord, at the Karolinska Institute in Sweden, while operating on patients with patent ductus arteriosus, “began to wonder whether it might not also be possible to treat coarctation of the aortic isthmus by surgical means.”10 The introduction of cardiac catheterization after World War II, a technique for which Andre F. Cournand and Dickenson W. Richards in the United States and Werner Forssman in Germany received the Nobel Prize in 1956, was a major step forward both diagnostically and in the study of circulatory physiology.2 The development of extracorporeal circulation in the early to mid-1950’s was destined to make virtually all congenital malformations of the heart accessible to the skills of cardiac surgeons. The stage was set for “accurate visualization of structures within the heart for a period sufficient to permit precise corrective measures.”11

The culmination of these historical landmarks was one of the most successful diagnostic and therapeutic achievements that medicine has witnessed. Formidable technical resources became accessible, permitting remarkably accurate anatomical and physiological diagnoses and astonishing feats of reparative surgery. Survival patterns were affected, often profoundly. Congenital heart disease should therefore be considered not only in terms of age of onset but also in terms of the age range that survival now permits—an uninterrupted continuum from fetal life to senescence.2,4 Although long-term management remains concerned with unoperated patients, medical management increasingly focuses on the growing numbers of postoperative patients who need surveillance. The quality of care provided by pediatric cardiologists from birth to maturity must be matched with care of equal quality for adults.

Unoperated adults experience improved longevity because of refinements in the management of arrhythmias and conduction disturbances, ventricular failure, pulmonary vascular disease, hematological disorders, renal function, urate metabolism, infective endocarditis, pregnancy, and noncardiac surgery. The management of patients after cardiac surgery or interventional catheterization requires knowledge of the intrinsic congenital cardiac or vascular malformation, the nature and effects of the therapeutic intervention, and the presence, type, and extent of postinterventional residua and sequelae. The ideal of cure in the literal sense is rarely achieved, however, so that a broad range of residua and sequelae are left behind and require prolonged, if not indefinite, medical attention that is essential if the concerns inherent in this new and increasing patient population are to be addressed properly.2,4


Date: 2014-12-21; view: 951


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