ABSTRACT
Congenital heart disease (CHD) is the most common birth anomaly. With advances in repair and palliation of these complex lesions, more and more patients are surviving and are discharged from the hospital to return to their families. Patients with CHD have complex health care needs that often must be provided for or coordinated for by the primary care provider (PCP) and medical home. This policy statement aims to provide the PCP with general guidelines for the care of the child with congenital heart defects and outlines anticipated problems, serving as a repository of current knowledge in a practical, readily accessible format. A timeline approach is used, emphasizing the role of the PCP and medical home in the management of patients with CHD in their various life stages.
Subject(s)
Academies and Institutes/standards , Heart Defects, Congenital/therapy , Patient-Centered Care/standards , Pediatrics/standards , Practice Guidelines as Topic/standards , Child , Health Policy , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/epidemiology , Humans , Patient-Centered Care/methods , Pediatrics/methods , United States/epidemiologySubject(s)
Heart Valve Diseases/therapy , Adolescent , Adult , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/therapy , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/therapy , Female , Heart Defects, Congenital/therapy , Heart Valve Diseases/complications , Heart Valve Diseases/diagnosis , Heart Valve Prosthesis/adverse effects , Humans , Intraoperative Period , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/therapySubject(s)
Antibiotic Prophylaxis/standards , Endocarditis/epidemiology , Endocarditis/prevention & control , Heart Valve Diseases/epidemiology , Antibiotic Prophylaxis/statistics & numerical data , Comorbidity , Dental Prophylaxis , Digestive System Surgical Procedures , Humans , Rheumatic Fever/prevention & control , Urogenital Surgical ProceduresSubject(s)
Antibiotic Prophylaxis , Endocarditis/prevention & control , Heart Valve Diseases/drug therapy , Rheumatic Heart Disease/prevention & control , Surgical Procedures, Operative/adverse effects , Adolescent , Adult , Aortic Valve Stenosis/drug therapy , Aortic Valve Stenosis/surgery , Catheterization/adverse effects , Endocarditis/etiology , Evidence-Based Medicine , Heart Valve Diseases/congenital , Heart Valve Diseases/surgery , Humans , Mitral Valve Prolapse/drug therapy , Mitral Valve Prolapse/surgery , Mitral Valve Stenosis/drug therapy , Mitral Valve Stenosis/surgery , Pulmonary Valve Stenosis/drug therapy , Pulmonary Valve Stenosis/therapy , Rheumatic Heart Disease/etiology , Treatment OutcomeABSTRACT
BACKGROUND: The purpose of this study is to identify independent echocardiographic predictors of mitral stenosis (MS)-related death or intervention in infants. Congenital MS is a rare and morphologically heterogeneous lesion with variable prognosis. Among patients diagnosed with MS in early infancy, echocardiographic factors associated with MS-related intervention or death have not been determined. METHODS AND RESULTS: The clinical and echocardiographic data of patients diagnosed with MS at age <6 months by echocardiography between 1986 and 2004 were reviewed. The primary outcome was a composite end point of either mitral valve (MV) intervention (catheter or surgery) or death related to MS. Multiple variables from the initial echocardiogram were analyzed for association with outcomes. Seventy-one patients (median age at diagnosis 63 days) fulfilled the inclusion criteria. Multivariate analysis identified higher initial MV mean inflow gradient (P = .009) and lower left ventricular (LV) diastolic length Z-score (P = .006) at presentation as predictors of intervention or death. Among patients with an initial MV inflow gradient < 2 mm Hg, none reached an end point, whereas, among patients with an initial mean gradient >/= 5.5 mm Hg, the risk of intervention or death was 85%. Among patients with a gradient > 2 and < 5.5 mm Hg, an end point was reached in 38%, and an LV diastolic length Z-score