Issue link: http://viewer.e-digitaledition.com/i/643923
ABOUT 1.5 MILLION adults in the United States have congenital heart disease (CHD). That figure will continue to rise. Currently, more than 40,000 children are born each year with some form of CHD. In previous generations, many did not live into adulthood; yet medical advancements have made it possible for children with structural heart problems to survive, and thrive, well into middle age and beyond. A critical component in facilitating positive outcomes for those with CHD is receiving appropriate follow-up care as they age. DEFINING ACHD Congenital heart disease is a general term applied to various heart defects present at birth; in fact, it's the most common type of birth defect and leads to more infant deaths within the first year of life than any other. These defects have no known cause, although in some instances genetics may play a role. Treatments vary widely, ranging from a wait-and-see approach to open heart surgery depending on the nature of the defect. Adult congenital heart disease (ACHD) is divided into three categories based on severity: simple lesions, moderate lesions and complex lesions. Broadly speaking, in adulthood, those with simple lesions can often be treated within the general cardiology practice setting whereas those with moderate or complex lesions are best managed in conjunction with an ACHD specialist. COMPLICATIONS ASSOCIATED WITH ACHD While most patients are diagnosed in childhood, it's not unusual to see patients present as adults. And even among those previously treated, patients often express the sentiment they were "fixed" in childhood — deeming follow-up care unnecessary. However, as patients age, lesions may aŸect their overall health and acquired diseases in adulthood can exacerbate their condition. For example, patients with ACHD who become pregnant often require careful monitoring. With increased blood volume during pregnancy and other physical changes, the added cardiac strain can jeopardize the health of both the mother and fetus. Among the general ACHD population, complications include arrhyth - mias, heart conduction abnormalities, heart failure, sudden death and other acquired adult disease GROWING ACHD POPULATION LARGELY UNDERSERVED These patients are highly complex and present a unique challenge to the medical community. Managing patients with ACHD diŸers from treating those with acquired cardiac disease. With ACHD, forming a treatment plan often involves the input of multiple caregivers with diŸerent subspecialty expertise. The treatment plan is individualized to the needs of the patient. Insuring patient compliance is important as well. Recognizing the unique needs of this patient population, this past year the American Board of Internal Medicine began to oŸer board certification in ACHD. To date, there are less than 200 board-certified physicians nationwide. At a more regional level, ACHD specialists in our area are engaging in eŸorts to pool resources to best address patients' needs. Last year, Akron Children's Hospital and Cleveland Clinic formed a partnership to collaborate on ACHD patient care. Dr. John Lane is board-certified in pediatric cardiology, adult cardiology and adult congenital heart disease. He is the Director of the Akron Children's Hospital Pediatric Cardiology and Adult Congenital Heart Service. ■ S P E C I A L C L I N I C A L S E C T I O N ❰❰❰❰❰ 1 3 Adult Congenital Heart Disease BY JOHN LANE, MD A Growing Challenge: M D N E W S . C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ M A R /A P R 2 016 1 3 BY JOHN LANE, MD