https://acpinternist.org/weekly/archives/2017/10/17/1.htm

Assess for noncardiac complications in congenital heart disease survivors, AHA says

Physicians who care for adult patients with congenital heart disease should be mindful of the effects that the condition has on other organs, according to a scientific statement from the American Heart Association.


Increasing life expectancy for patients born with congenital heart disease (CHD) has created a need to identify preventive strategies and interventions to mitigate the development of noncardiac complications, according to a scientific statement from the American Heart Association.

Noncardiac areas of concern for patients with CHD include renal dysfunction, restrictive lung disease, anemia, and cirrhosis; atherosclerotic cardiovascular disease and its risk factors in an aging population; and disorders of psychosocial and cognitive development, the statement said. The statement addresses the prevalence, pathogenesis, and management of potential conditions. It was published online Oct. 9 by Circulation.

“To further decrease morbidity and mortality in patients with CHD, understanding and managing noncardiac complications becomes as important as knowing their cardiac history,” the statement said. It reviews some of the organ systems most frequently affected in adults with CHD and areas of concern, including the following.

  • Pulmonology: pulmonary hypertension and pulmonary hemorrhages, among others;
  • Hepatology: congestive hepatopathy, cardiac cirrhosis, and Fontan-associated liver disease;
  • Immunology/infectious disease: infective endocarditis, pneumonia, and brain abscess, among others;
  • Hematology: secondary erythrocytosis/iron deficiency (cyanotic CHD), thromboembolism, and anemia;
  • Oncology: hepatocellular carcinoma, age-appropriate cancer screening;
  • Psychosocial: depression, anxiety;
  • Endocrinology: thyroid, calcium hemostasis/bone health, obesity/metabolic syndrome, diabetes, dyslipidemia;
  • Nephrology: chronic kidney disease, cardiorenal syndrome; and
  • Vascular: cerebrovascular disease, peripheral venous/arterial disease, and hypertension, among others.

The paper also addressed peri- and postoperative management and special needs populations.

“In summary, adults with CHD often have complex multisystemic disease for which both cardiac outcomes and noncardiac complications warrant clinical attention and empirical investigation; an interdisciplinary approach is required across the life span of these patients,” the statement said. “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.”