New Subspecialty of Adult Congenital Heart Disease Now Available to Address Unique Cardiac Needs
Due to advances in treatment and technology, more patients than ever before who are born with congenital heart disease (CHD) are living into adulthood. For the first time, there are more adult than pediatric CHD patients, with the number of adult cases in the U.S. estimated at 1.3 million.1The management of these patients is so complex that a new subspecialty of adult congenital heart disease (ACHD) is now available for certification by theAmerican Board of Medical Specialties.Penn State Heart and Vascular Institutehas long recognized the complex needs of this growing population, and started a program for adult congenital heart disease (PACHD) in 1991, which is directed byWilliam Davidson, Jr., MD.
彩色多普勒图像严重的肺的insufficiency, commonly found in Tetralogy of Fallot patients.
Currently, the PACHD has three ACHD providers, all of whom are board certified, having sat for the first-ever ACHD subspecialty boards in October 2015. These specialized clinicians provide 24/7 coverage to all ACHD inpatients, and provide personalized, consistent care to complex patients, most of whom have six to 10 active medical conditions. Problems associated with congenital heart disease include valve disease, heart failure, arrhythmias, aortic and other vascular diseases; pulmonary, renal and liver disease; and a history of multiple surgeries. For example, one of the fastest growing ACHD patient populations have tetralogy of Fallot (ToF).2这种情况需要复杂的心脏内“纠正”手术。一个普遍的后果是肺动脉瓣不足（PI），可能导致右心室功能障碍和猝死。2根据戴维森博士的说法，PI是该人群中常见的病变。所有ACHD患者都需要终身随访和定期去ACHD专家。
As the patients age, so does the natural history of CHD; many adult patients have problems not detected in childhood or adolescence. The PACHD also focuses on the growing burden of arrhythmia and its concomitant risk of sudden death, the role of the right ventricle in heart failure among this population and the importance of interventional cardiology, as opposed to open surgery, whenever possible.
戴维森博士共同撰写，在美国心脏病学院（ACC）的第32届贝塞斯达会议上制定的指南，指出：“所有患有复杂先天性心脏缺陷的成年人都应在专业的ACHD护理中心看到。”3Unfortunately, only about 10 percent of adult CHD patients seek appropriate care from adult congenital cardiologists, and estimates put the number of adults with CHD who receive any sort of cardiovascular care at just below half.4Dr. Davidson also points out that Canadian data have shown having treatment dedicated to adult congenital heart disease reduced hospitalizations by 4 percent per year and can improve outcomes overall in this population.5“Specialty cardiovascular care is so key,” he says, “and helps us determine if patients can return to the care of their primary cardiologists or need specialized care throughout their lives to prevent unnecessary complications and premature death.”
William R. Davidson Jr., MD
Professor, Medicine
先天性心脏病成人计划主任
电话：717-531-7473
电子邮件：wdavidson@pennstatehealth.psu.edu
奖学金：有氧运动logy, University of Rochester Medical Center, Rochester, N.Y.
住院医师:宾夕法尼亚州费城宾夕法尼亚医院内科医学。
Medical School:University of Pennsylvania School of Medicine, Philadelphia, Pa.
与Doximity的心脏病学系联系
参考：
- Moodie D.Adult Congenital Heart Disease: Past, Present, and Future.Tex Heart Inst J.2011;38（6）：705–706。
- Suleiman T, Kavinsky CJ, Skerritt C, Kenny D, Ilbawi MN, and Caputo M.法洛修复四边形后，肺动脉瓣更换的最新发展：混合方法的出现.Front Surg.2015; 2：22。
- http://www.achaheart.org/resources/ for-patients/achd-care-guidelines.aspx. Accessed September 24, 2015.
- Nainggolan L. Adult Congenital Heart Disease a New Subspecialty. Heartwire from Medscape.com. December 12, 2012.
- 伊斯兰S，Yasui Y，Kaul P，Marelli AJ，Mackie AS。加拿大先天性心脏病住院治疗：10年的经验.Can J Cardiol.2015年6月4日。PII：S0828-282X（15）00404-3。