John Libbey Eurotext

MT Cardio


Diagnosis of congenital heart disease Volume 3, issue 2, Mars-Avril 2007


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Unité de cardiopathie congénitale de l’adulte, Pôle cardiovasculaire, hôpital européen Georges Pompidou, 15 rue Leblanc, 75015 Paris, Service de cardiologie pédiatrique, hôpital Necker Enfants Malades, Paris

Diagnosis of congenital heart disease (CHD) in adulthood is not unusual. Adult CHD is often suspected by clinical examination and confirmed by echocardiography (which is part of the clinic for adult patients with congenital heart defects). Lesions can be simple, such as atrial septal defect, arterial duct, native coarctation or pulmonary stenosis. The patient can also survive into adulthood with a complex defect as Ebstein disease or double discordance. TOE can reliably assess intra cardiac defects. In adults complete assessment is generally achieved with MRI or CT scanners in experienced centers. Use of cardiac catheters for diagnosis is mainly for pulmonary resistance assessment. Interventional catheterism is an increasingly used technique (ASD or duct closure, balloon dilatation of pulmonary stenosis). The managment of these patients is frequently complex because of the evolution of native disease (calcifications of abnormal congenital valves, arrythmias, pulmonary artery disease), or because of acquired cardiac pathology as systemic hypertension, and sometimes coronary artery disease. The majority of patients with CHD have been operated on in infancy. Initial diagnostics are often known, but sequellae and complications can be specific. About 50% of these patients require careful follow up, as some of them will need further operations, interventional catheterism or interventional antiarrythmic procedures in adulthood.