Somerville J
GUCH Unit, Royal Brompton Hospital, London, United Kingdom.
Annu Rev Med. 1997;48:283-93. doi: 10.1146/annurev.med.48.1.283.
A small new population of patients in cardiology, the grown-up (adult) congenital hearts (GUCH), need superspecialist care and expertise, particularly those patients with complex defects previously operated on in childhood or who were not operated on. Arrhythmias are the most common cardiologic reason for admission to the hospital, and atrial flutter is the most frequent disorder of rhythm, usually related to hemodynamic disturbances. The GUCHs need solutions to problems of transition of care, ideally an adolescent area for the younger patients, knowledge of which and when to investigate each anomaly, expertise in cardiac catheterization and interventions, cardiac surgeons experienced in congenital as well as adult disease since one in five admissions are for cardiac surgery, at-risk pregnancy service, counseling on life's problems, and most of all a few dedicated centers with cardiologists and surgeons trained in this subspecialty. The profession needs to achieve optimal care for these precious patients, particularly those with complicated lesions and complex surgery, particularly with the valve replacements. Although small in number and high in expense, GUCH patients should be centralized so expertise and experience can be concentrated despite the need to cross barriers of finance and bureaucracy. Currently, with the exception of a few expert centers, these patients receive suboptimal medical management.
心脏病学领域出现了一小群新的患者群体，即成年先天性心脏病患者（GUCH），他们需要超专科护理和专业知识，尤其是那些童年时期接受过复杂缺陷手术或未接受手术的患者。心律失常是住院最常见的心脏病学原因，心房扑动是最常见的节律紊乱，通常与血流动力学紊乱有关。GUCH患者需要解决护理过渡问题，理想情况下为年轻患者设立一个青少年专区，了解每种异常情况及其检查时机的知识，心脏导管插入术和干预方面的专业知识，由于五分之一的住院患者需要进行心脏手术，因此需要有先天性和成人疾病方面经验的心脏外科医生，提供高危妊娠服务，就生活问题提供咨询，最重要的是需要一些有在该亚专业接受过培训的心脏病专家和外科医生的专门中心。该行业需要为这些珍贵的患者提供最佳护理，尤其是那些有复杂病变和复杂手术的患者，特别是瓣膜置换患者。尽管GUCH患者数量少且费用高，但仍应集中管理，以便集中专业知识和经验，尽管需要跨越财务和官僚障碍。目前，除了少数专家中心外，这些患者得到的医疗管理并不理想。
