Special considerations in the management of adult congenital heart disease.

Special considerations for the management of adult congenital heart disease include pregnancy-related cardiovascular disease, pulmonary arterial hypertension, and arrhythmias. Improvements in the treatment of congenital heart disease mean that more women with congenital heart disease are reaching childbearing age. In BC the Cardiac Obstetrics clinic at St. Paul's Hospital provides coordinated care for pregnant women with cardiac conditions. The clinic also offers preconception counseling so that couples can make informed choices about pregnancy. Another service based at St. Paul's Hospital, the Pacific Adult Congenital Heart clinic, helps manage patients with pulmonary arterial hypertension, a progressive condition affecting around 10% of adult congenital heart disease patients. Agents used to treat pulmonary arterial hypertension include endothelin receptor antagonists and phosphodiesterase type 5 inhibitors. The Pacific Adult Congenital Heart clinic also manages patients with a significant arrhythmia, often the first manifestation of deterioration in complex congenital heart disease. Complications that can result from arrhythmias include heart failure, thromboembolism, and sudden cardiac death. A range of complementary imaging modalities aid in the management of all these conditions by enabling the assessment of ventricular and valvular function (echocardiography and magnetic resonance imaging), quantification of right ventricular volume (multidetector computed tomography), and exclusion of coronary stenosis (coronary CT angiography). [ABSTRACT FROM AUTHOR]