Journal presentation

Moderator: Presentator:
Dr. Arif Hossain Dr. Shah Md. Nahid Aktarul Islam
Assistant Professor MD ( Cardiology) Phase-B resident
NICVD, Dhaka NICVD, Dhaka
Focus point:
• General aspects
• Atrial septal defect
• Ventricular septal defect
• Patent ductus arteriosus (PDA)
• Tetralogy of fallot
• Therapeutic considerations
Classification of congenital heart disease complexity
Classification of congenital heart disease complexity
Classification of congenital heart disease complexity
Diagnostic work-up
• Echocardiography
• Cardiovascular magnetic resonance imaging (CMR)
• Cardiovascular computed tomography (CCT)
• Cardiopulmonary exercise testing
• Cardiac catheterization
• Biomarkers
Atrial septal defect
Recommendations for intervention in atrial septal defect (native and residual)
Recommendation cont.
Atrioventricular septal defect
Ventricular septal defect
Recommendations for intervention in ventricular septal defect (native and residual)
Patent ductus arteriosus
Recommendations for intervention in patent ductus arteriosus
Selected revised recommendations (R), new recommendations (N), and new
concepts of shunt lesions:
Continue:
Tetralogy of Fallot
Recommendations for intervention after repair of tetralogy of Fallot
Therapeutic considerations
• Heart failure
• Arrhythmias and sudden cardiac death
• Pulmonary hypertension
• Surgical treatment
• Catheter intervention
• Infective endocarditis
• Antithrombotic treatment
• Management of cyanotic patients
Arrhythmias and sudden cardiac death
Risk estimates for arrhythmic events and bradycardias in ACHD
Recommendations for treatment of arrhythmias in adult congenital heart disease
Recommendation for ICD implantation in CHD
Recommendation for ICD implantation in CHD
Pulmonary hypertension
Definitions of pulmonary hypertension subtypes and their occurrence in ACHD
Recommendations for treatment of pulmonary arterial hypertension associated with congenital heart disease
Take home messages:
• In patients with non-invasive signs of elevated PAP, heart catheterization
with assessment of PVR is mandatory.
• In the presence of PVR >_5WU, ASD closure should be avoided.
• VSD and PDA closure may only be considered in selected patients with
significant shunt after careful evaluation in an ACHD and PH expert
Centre.
• Device closure is the treatment of choice when technically feasible.
• Correct blood pressure measurement (right arm, ambulatory) is essential
in the follow-up of patients with CoA.
• The most recent definition of PH lowers mean PAP from >_25 mmHg to
>20 mmHg but additionally requires a PVR >_3 WU for pre-capillary PH.
Take home messages:
• Maintenance of sinus rhythm is the aim in most ACHD patients.
• High suspicion of PAH, and regular assessment for the presence of
PAH in patients with shunt lesions, after defect closure is
recommended.
• Women with CHD and confirmed pre-capillary PH should be
counselled against pregnancy.
• Routine phlebotomies must be avoided as they put patients at risk for
iron-deficient anaemia and cerebrovascular complications.
• Therapeutic phlebotomy is only indicated in the presence of
moderate/severe hyperviscosity symptoms.