Well, in conclusion, I’ve given you a very
quick look at congenital heart disease. As
I said in the beginning, this is a very complex
area that’s actually the purview of a group
of cardiologists, the pediatric cardiologists
who, again, often in conjunction with adult
cardiologists, continue to follow these patients
for their whole life, particularly where there
are residual defects, as I just mentioned
in the patient with cyanotic congenital heart
disease. There’s excellent catheter and
surgical treatment for these patients. They
all have very specific findings on physical
exam and EKGs and echos. I didn’t go into
this in great detail because it’s a whole
area of itself, but suffice it to say that
with careful thought and examination, the
adult cardiologist can usually identify these
lesions based on patient’s history and
the physical findings. And of course, this
is followed up with a number of imaging tests
- echo, CT or MRI give a beautiful map of
the lesion, often which the surgeons want
ahead of time to look at before they go in.
And the results of surgical intervention or
catheter intervention are very, very good
for the vast majority of patients, with the
exception of the individuals with cyanotic congenital
heart disease who often continue to have disability
and problems. But, the good news is that most
individuals with congenital heart disease
actually lead long and productive lives with
minimal disability. Why? Because they’ve
had the defect closed, often in childhood,
there’s not pulmonary vascular disease,
they don’t turn blue, they function very
well. Some even are competitive athletes.
The residual problems are often in the patient
with the complex lesions that lead to cyanosis
at birth, as we talked about - the transpositions
where the aorta and pulmonary artery are reversed.
These individuals have a number of palliative
operations and they often have residual disability.
Fortunately, they’re a very small group.
The majority of patients with congenital heart
disease either have the obstructive lesions -
pulmonic stenosis and aortic stenosis, or
the holes in the heart - the ASD, the VSD.
Usually, these do extremely well with our
current therapy and often, they don’t need
cardiac surgery. Often the defects can be
closed with catheter devices. So it’s a
very good time for congenital heart disease
with the exception of the people who had cyanotic
congenital heart disease. They often require
considerable follow-up and care, and as I mentioned
before, it’s usually co-ordinated care between
the pediatric cardiologist and the adult cardiologist.