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The article discusses new developments in causes, diagnosis, early treatment and late outcomes of tetralogy of Fallot with an emphasis on the continuum of multidisciplinary care necessary for best possible lifelong treatment of the 1% of the population born with congenital heart diseases. Tetralogy of Fallot is described as the most common form of cyanotic congenital heart disease and one of the first that reported success when repaired by congenital heart surgeons. This congenital heart disorder is frequently diagnosed during fetal life similar to many complex heart diseases. Also noted are the postoperative complications experienced by children with the disorder, including low card output symptom.

Objectives: This study sought to determine what adolescents and young adults with moderate to complex congenital heart disease (CHD) believe their life span to be and to examine correlates of their beliefs. Background: Patients with moderate to complex CHD have a shortened life expectancy. Patients’ perceptions of their life expectancy have not been examined. Methods: Young adults and older adolescents with moderate or complex CHD (n = 296) estimated their own life expectancy and that of healthy peers, and rated their health status and risk of CHD complications. Adults with CHD discussed reasons for life expectancy ratings in an interview. Results: Patients with CHD expected to live to age 75 ± 11 years, only 4 years less than their healthy peers. Over 85% of patients expected to live longer than our estimates of their life expectancy. Poorer health status and higher perceived risk of CHD complications related to shorter perceived life expectancy. Young adults lacked awareness and understanding of CHD-specific risks, and their life expectancy perceptions often related to risk factors for coronary artery disease. Conclusions: Patients with moderate to complex CHD expect to live almost as long as their healthy peers. For most patients, this is unlikely. The implications of these beliefs on health behaviors and life choices are unknown, but should be examined. Nevertheless, patients need accurate information delivered in a sensitive manner to make informed life choices regarding education, careers, and family. [Copyright &y& Elsevier]

The article presents the author's view on the study conducted by Joseph T. Poterucha and colleagues on the survivability of patients with an unrepaired single heart ventricle. Topics discussed include the author's assessment of the medical study, an overview of the report compiled by the professional organization Adult Congenital Heart Association regarding congenital heart surgeries, and the author's opinion regarding the significance of the report.

Abstract: Objectives: To examine the sexual behaviors and reproductive concerns among patients with moderate to complex congenital heart disease (CHD). Background: There is a growing need to understand and address the psychosocial issues for older adolescents and young adults with CHD. Emerging sexuality is an issue for this age group and pregnancy for many women with CHD is risky. But, patients'' sexual behavior and reproductive concerns have not been studied. Methods: Young adults (19–20 years old; n =212) and adolescents (16–18 years old; n =144) with moderate to complex CHD reported their sexual behaviors and reproductive concerns. Data were compared to normative samples from Canada and the United States. Results: Few adolescents (14%) but many young adults (48%) with CHD were sexually active (at least one partner in the previous 3 months). These rates were lower than those of their healthy peers. Among the sexually active patients, 36% of the young adults and 72% of the adolescents engaged in one or more types of potentially risky sexual behavior (i.e., two or more partners in the past 3 months, questionable birth control, using drugs or alcohol before sex at least sometimes). Women with complex CHD had the highest levels of concern regarding their fertility and risk of genetic transmission of CHD, as well as concerns about adverse effects of pregnancy on their own health. Conclusions: Sexual health should be discussed with adolescents and young adults with CHD. Particular attention should be given to discussing sexual health with women who have complex CHD. [Copyright &y& Elsevier]

Atrial tachyarrhythmias (ATs) contribute substantially to morbidity in adult patients with secundum atrial septal defects (ASDs). The purpose of this study was to prospectively determine the incidence of AT in adults with an ASD and identify predictors of AT occurrence after closure. This was a prospective study of 200 adult patients undergoing closure of a secundum ASD. Arrhythmic events were defined as sustained or symptomatic AT requiring treatment. Twenty percent of patients (mean age 50 ± 17 years; 26% men) referred for ASD closure had a history of AT. Early follow-up was available for 90% of patients, and the prevalence of AT was 17%. Of 171 patients with late follow-up (mean 1.9 ± 0.9 years), data were available for 90%. AT was detected in 16% of these patients. Closure resulted in alleviation of symptoms (p <0.001), but symptoms alone did not identify patients at risk of recurrent AT. After closure of the ASD, the likelihood of remaining arrhythmia free was highest in patients without a history of AT (p = 0.001) and those <40 years at closure (p = 0.04). In conclusion, transcatheter ASD closure in patients without a history of arrhythmias and those <40 years of age conferred the highest likelihood of a patient remaining arrhythmia free in follow-up. An arrhythmia-specific treatment strategy should be considered for patients with documented established AT before ASD closure, in addition to shunt relief. [Copyright &y& Elsevier]