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Canadian Journal of Cardiology

Canadian Cardiovascular Society 2009 Consensus Conference on the management of adults with congenital heart disease: Executive summary

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      With advances in pediatric cardiology and cardiac surgery, the population of adults with congenital heart disease (CHD) has increased. In the current era, there are more adults with CHD than children. This population has many unique issues and needs. They have distinctive forms of heart failure, and their cardiac disease can be associated with pulmonary hypertension, thromboemboli, complex arrhythmias and sudden death. Medical aspects that need to be considered relate to the long-term and multisystemic effects of single-ventricle physiology, cyanosis, systemic right ventricles, complex intracardiac baffles and failing subpulmonary right ventricles. Since the 2001 Canadian Cardiovascular Society Consensus Conference report on the management of adults with CHD, there have been significant advances in the understanding of the late outcomes, genetics, medical therapy and interventional approaches in the field of adult CHD. Therefore, new clinical guidelines have been written by Canadian adult CHD physicians in collaboration with an international panel of experts in the field. The present executive summary is a brief overview of the new guidelines and includes the recommendations for interventions. The complete document consists of four manuscripts that are published online in the present issue of The Canadian Journal of Cardiology, including sections on genetics, clinical outcomes, recommended diagnostic workup, surgical and interventional options, treatment of arrhythmias, assessment of pregnancy and contraception risks, and follow- up requirements. The complete document and references can also be found at www.ccs.ca or www.cachnet.org.
      Étant donné les progrès de la cardiologie pédiatrique et de la chirurgie cardiaque, la population d’adultes ayant une cardiopathie congénitale (CPC) a augmenté. Il y a maintenant plus d’adultes que d’enfants ayant une CPC. Cette population a de nombreux problèmes et besoins uniques. Ils ont des formes particulières d’insuffisance cardiaque, et leur maladie cardiaque peut s’associer à une hypertension pulmonaire, à des thromboembolies, à des arythmies complexes et à une mort subite. Les aspects médicaux à envisager sont liés aux effets multisystémiques et à long terme de la physiologie monoventriculaire, de la cyanose, des ventricules droits systémiques, des cloisons intracardiaques complexes et de l’insuffisance du ventricule droit sous-pulmonaire. Depuis le rapport de la conférence consensuelle 2001 de la Société canadienne de cardiologie sur la prise en charge des adultes ayant une CPC, on constate d’importantes avancées dans la compréhension des issues tardives, de la génétique, de la thérapie médicale et des démarches d’intervention dans le domaine des CPC chez les adultes. Par conséquent, de nouvelles lignes directrices cliniques ont été rédigées par des médecins canadiens s’occupant des CPC chez les adultes, en collaboration avec un groupe d’experts internationaux dans le domaine. Le présent résumé donne un bref aperçu des nouvelles lignes directrices et contient les recommandations d’interventions. Le document complet se compose de quatre manuscrits publiés par voie électronique dans le présent numéro du Journal canadien de cardiologie, y compris des rubriques sur la génétique, les issues cliniques, les bilans diagnostiques recommandés, les possibilités chirurgicales et d’intervention, le traitement des arythmies, l’évaluation des risques de la grossesse et de la contraception et les recommandations de suivi. Le document complet et les références figurent également aux adresses www.ccs.ca et www.cachnet.org.

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