Circulation. 2017 Nov 14;136(20):e348-e392. doi: 10.1161/CIR.0000000000000535. Epub 2017 Oct 9.
Life expectancy and quality of life for those born with congenital heart disease (CHD) have greatly improved over the past 3 decades. While representing a great advance for these patients, who have been able to move from childhood to successful adult lives in increasing numbers, this development has resulted in an epidemiological shift and a generation of patients who are at risk of developing chronic multisystem disease in adulthood. Noncardiac complications significantly contribute to the morbidity and mortality of adults with CHD. Reduced survival has been documented in patients with CHD with renal dysfunction, restrictive lung disease, anemia, and cirrhosis. Furthermore, as this population ages, atherosclerotic cardiovascular disease and its risk factors are becoming increasingly prevalent. Disorders of psychosocial and cognitive development are key factors affecting the quality of life of these individuals. It is incumbent on physicians who care for patients with CHD to be mindful of the effects that disease of organs other than the heart may have on the well-being of adults with CHD. Further research is needed to understand how these noncardiac complications may affect the long-term outcome in these patients and what modifiable factors can be targeted for preventive intervention.
在过去的 30 年中,患有先天性心脏病 (CHD) 的人的预期寿命和生活质量得到了极大改善。虽然这代表了这些患者的巨大进步,他们能够越来越多地从童年过渡到成功的成年生活,但这种发展导致了流行病学的转变,产生了一代在成年后有患慢性多系统疾病风险的患者。非心脏并发症极大地增加了患有 CHD 的成年人的发病率和死亡率。有肾功能障碍、限制性肺病、贫血和肝硬化的 CHD 患者的存活率已经降低。此外,随着这一人群的老龄化,动脉粥样硬化性心血管疾病及其危险因素的发病率越来越高。社会心理和认知发展障碍是影响这些个体生活质量的关键因素。照顾 CHD 患者的医生有责任注意到除心脏以外的其他器官的疾病可能对 CHD 成年患者的健康产生的影响。需要进一步研究以了解这些非心脏并发症如何影响这些患者的长期预后,以及哪些可改变的因素可以作为预防干预的目标。