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Heart failure in adult congenital heart disease

Session presentations
  • The failing systemic right ventricle. Presented by A Redington (Toronto, CA) See the slides
  • The role of biomarkers. Presented by C Mueller (Basel, CH) See the slides
  • What is different about drug treatment? Presented by G P Diller (London, GB) See the slides
  • Suitability for and results of transplantation. Presented by M Chaudhari (Newcastle Upon Tyne, GB) See the slides
Congenital Heart Disease in Children and Adults (GUCH)

Professor Andrew Redington began the symposium by identifying the conditions at greatest risk for developing heart failure: patients with single ventricles; patients with congenitally corrected transposition, and patients with Mustard or Senning repair of transposition of the great arteries (TGA).  Data suggests that patients who have had a Fontan procedure for hypoplastic left heart syndrome may do as well as those with other forms of CHD. There is little evidence for an ‘inherently’ failing RV.  He identified dysnchrony as a possible cause of myocardial perfusion abnormalities.  In patients with CCTGA he pointed out the importance of ventricular septal shift in modulating tricuspid regurgitation and systemic right ventricular function. In atrial switch patients, pulmonary artery banding has been disappointing so far, but the concept should be pursued.

Dr. Christian Mueller of Basel spoke about the role of biomarkers in ACHD patients with heart failure.  He strongly encouraged the regular measurement of BNP levels to help identify patients at increased risk, to help determine prognosis, and to help guide therapy, even though BNP levels are much lower in ACHD patients with heart failure than is the case in heart failure in patients with acquired heart disease.

Dr. Gerhard Diller of London took on the challenge of helping guide the medical management of congestive heart failure in the absence of good scientific evidence of efficacy.  He suggested that registry data from CONCOR and other sources may well help guide us in the future.

Dr. Milind Chaudhari of Newcastle Upon Tyne reported on the role of heart transplantation in ACHD patients with advanced heart failure.  In the experience of his center, 3% of transplants go to CHD patients.  He pointed out that ACHD patients do somewhat better after heart transplantation than do other diagnostic groups, perhaps because they are younger.  Ventricular assist devices (VADs) are presently being used as bridge to transplantation, but the pending availability of Level 5 VADS may put them in the position of destination therapy for such patients.
There will be many more heart failure patients with CHD as the population expands and ages.  The challenges will thus expand, as will hopefully effective measures to prevent and manage these ACHD patients.




Heart failure in adult congenital heart disease

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.