Cardiac Intensive Care Unit, Okayama University Hospital, Okayama, Japan.
J Cardiol. 2012 Sep;60(3):151-9. doi: 10.1016/j.jjcc.2012.06.014. Epub 2012 Aug 11.
Adult congenital heart disease is one of the most important clinical issues not only for pediatric cardiologists but also adult cardiologists. After the introduction of catheter intervention for atrial septal defect in the pediatric population, therapeutic advantages of this less invasive procedure now focused on even geriatric patients. The most valuable clinical benefit of this procedure is the significant improvement in symptoms and daily activities, which result from the closure of left to right shunt without thoracotomy or cardiopulmonary bypass surgery. Although currently available therapeutic options for device closure for congenital heart disease in Japan are limited to atrial septal defect, patent ductus arteriosus, or some vascular abnormalities such as coronary arteriovenous fistula, various new techniques or devices such as ventricular septal defect device, pulmonary valve implantation, are going to be introduced in the near future. To perform safely and achieve good procedure success, real time imaging plays an important role in interventional procedures. Real time three-dimensional transesophageal echocardiography can provide high quality imaging for anatomical evaluation including defect size, surrounding rim morphology, and the relationship between device and septal rim. In adult patients, optimal management of comorbidities is an important issue, including cardiac function, arrhythmias, pulmonary function, and renal function. In particular, atrial arrhythmias are key issues for long-term outcome. Because the interventional procedures are not complication-free techniques, the establishment of a surgical back-up system is essential for achieving a safe procedure. Finally, the establishment of a team approach including pediatric and adult cardiologists, cardiac surgeons, and anesthesiologists is the most important factor for a good therapeutic outcome. Their roles include pre-interventional hemodynamic evaluation, good imaging technique for anatomical evaluation, management of comorbidities, and surgical back up.
成人先天性心脏病不仅是儿科心脏病专家，也是成人心脏病专家的重要临床问题之一。在儿科人群中引入经导管房间隔缺损介入治疗后，这种微创治疗的优势现在集中在甚至老年患者身上。该手术最重要的临床益处是，由于左向右分流的关闭，无需开胸或体外循环手术，症状和日常活动得到显著改善。尽管目前日本用于先天性心脏病器械闭合的治疗选择仅限于房间隔缺损、动脉导管未闭或一些血管异常，如冠状动静脉瘘，但各种新技术或器械，如室间隔缺损器械、肺动脉瓣植入术，将在不久的将来引入。为了安全地进行手术并取得良好的手术成功率，实时成像在介入手术中起着重要作用。实时三维经食管超声心动图可提供高质量的成像，用于解剖评估，包括缺损大小、周围边缘形态以及器械与间隔边缘的关系。在成年患者中，合并症的最佳管理是一个重要问题，包括心功能、心律失常、肺功能和肾功能。特别是，房性心律失常是长期预后的关键问题。由于介入治疗并非无并发症的技术，因此建立手术后备系统对于实现安全手术至关重要。最后，包括儿科和成人心脏病专家、心脏外科医生和麻醉师在内的团队方法的建立是良好治疗结果的最重要因素。他们的角色包括术前血流动力学评估、解剖评估的良好成像技术、合并症管理和手术后备。
