Pediatric Cardiology, Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
J Intern Med. 2020 Oct;288(4):383-389. doi: 10.1111/joim.13080. Epub 2020 May 11.
The prognosis of patients with congenital heart defects has improved significantly: more and more patients reach adulthood and old age. At the same time, the possibility of cardiovascular morbidity increases. The conventional risk factors for coronary artery disease are at least as high or even higher in patients than in the general population. Obesity and sedentary life style are more common in adults with congenital heart defect (ACHD) than in general population. In some patients, for example those with coarctation of the aorta or patients with operated coronary arteries in the infancy, the incidence of coronary artery disease (CAD) is clearly increased. In some patients with cyanotic heart defects (e.g. Fontan), the incidence of CAD might be lower, but it usually returns to the average level or higher after correction of the defect. Coronary artery disease is one of the most important reasons for mortality also in ACHD patients, and the consequences of a coronary event might be more fateful in a patient with a corrected congenital heart defect than in her/his peer. There should be a paradigm shift from operative mortality and short-term outcome to long-term morbidity and prevention of cardiovascular disease - a task that often has been forgotten during follow-up visits.
越来越多的患者能够进入成年和老年期。与此同时，心血管疾病发病的可能性增加了。与一般人群相比，冠心病的传统危险因素在患者中至少一样高，甚至更高。肥胖和久坐的生活方式在先天性心脏病（ACHD）患者中比在一般人群中更为常见。在某些患者中，例如主动脉缩窄或婴儿期接受过冠状动脉手术的患者，冠心病的发病率明显增加。在一些发绀性心脏缺陷（如法洛四联症）患者中，CAD 的发病率可能较低，但在缺陷矫正后通常会恢复到平均水平或更高。冠心病也是 ACHD 患者死亡的最重要原因之一，与同龄人相比，患有矫正先天性心脏病的患者发生冠状动脉事件的后果可能更具决定性。应该从手术死亡率和短期结果转变为长期发病率和心血管疾病的预防——这是在随访期间经常被忽视的任务。
