Baumgartner Helmut, Däbritz Sabine
EMAH-Zentrum/Kardiologie, Zentrum für Erwachsene mit angeborenen und erworbenen Herzfehler, Universitätsklinikum Münster, Albert-Schweitzer-Strasse 33, Münster.
Med Klin (Munich). 2008 Mar 15;103(3):135-42. doi: 10.1007/s00063-008-1020-4.
While a few decades ago only a minority of patients, particularly of those with complex congenital heart disease, could reach adulthood, progress of pediatric cardiology and cardiac surgery allows now the survival of the majority. Thus, adult cardiology is faced with a new challenging patient population. Since only a few congenital heart defects can be cured, regular follow-up during adult life is of major importance. Residual as well as consequently developed lesions must be recognized. Optimal timing of surgery or catheter intervention is necessary to provide the best long-term outcome. Despite optimal treatment part of the patients will develop long-term complications such as arrhythmias, pulmonary hypertension and, eventually, heart failure. Acute complications such as arrhythmias, aortic dissection or rupture, endocarditis, cerebral events due to embolism, bleeding or abscesses, and pulmonary embolism or bleeding must be recognized early and treated appropriately. Management of noncardiac surgery, pregnancy and delivery can be challenging. Another task is counseling regarding exercise and sports, choice of profession, driving and insurance issues. Finally, psychosocial issues must be taken into account for appropriate care of this special patient group.
几十年前，只有少数患者，特别是患有复杂先天性心脏病的患者能够活到成年，而如今，小儿心脏病学和心脏外科的进展使大多数患者得以存活。因此，成人心脏病学面临着一个新的具有挑战性的患者群体。由于只有少数先天性心脏缺陷能够治愈，成年期的定期随访至关重要。必须识别残留病变以及随后出现的病变。为了获得最佳的长期效果，手术或导管介入的最佳时机是必要的。尽管进行了最佳治疗，部分患者仍会出现长期并发症，如心律失常、肺动脉高压，最终发展为心力衰竭。必须尽早识别并适当治疗急性并发症，如心律失常、主动脉夹层或破裂、心内膜炎、栓塞、出血或脓肿引起的脑部事件以及肺栓塞或出血。非心脏手术、妊娠和分娩的管理可能具有挑战性。另一项任务是就运动、职业选择、驾驶和保险问题提供咨询。最后，为了对这个特殊患者群体进行适当护理，必须考虑心理社会问题。
