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Foreword T h e J o u r n e y t o A d u l t Co n g e n i t a l Heart Disease

Lucky Jain, MD, MBA Consulting Editor

The growing number of births to mothers who themselves had significant congenital heart disease marks a remarkable milestone in our journey of caring for these complex patients (Fig. 1).1 One such patient at our institution was a survivor of single-ventricle physiology, complete with the usual share of complications such as pulmonary hypertension. The large-scale planning required to manage this pregnancy, and to take it beyond the threshold of viability, was pretty remarkable. Equally fascinating was the depth of understanding of the complex physiologic interactions of the mother and fetus.2 In the end, the delivery was early but relatively free of complications, and the newborn blossomed under the care of our neonatology team, unencumbered by the limits of intrauterine oxygen and nutrient delivery. I remember the sight of this young mom holding her precious baby for a few fleeting moments before being whisked away to the NICU. This story makes me giddy with joy, to see the remarkable collaborative work between a large team of talented providers, including pediatric and adult cardiologists, neonatologists, perinatologists, and elaborate support services linked to these specialties. It also makes me proud to have been a part of this journey and to have participated in care of these patients early on in their lives: the journey of near certain death for a baby with complex congenital heart, to a similar patient 20 years later giving birth to a healthy child is pretty amazing! This remarkable journey of pediatric cardiology has been fueled by an intense grounding of the subspecialty in fundamentals of physiology, and a partnership between surgical and medical teams like none other. Biomedical engineering has also played a key role in refining care, as has the ability to image hearts noninvasively from early on in fetal life. Yet, pregnant or not, many adult congenital heart patients don’t do that well, particularly patients with Eisenmenger physiology, severe pulmonary hypertension, significant ventricular outflow obstruction, and ventricular dysfunction.3 Pregnancy, labor, and the rigors of delivery increase the hemodynamic stress on the cardiovascular Clin Perinatol - (2015) -–http://dx.doi.org/10.1016/j.clp.2015.12.002 perinatology.theclinics.com 0095-5108/15/$ – see front matter Ó 2015 Published by Elsevier Inc.

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Fig. 1. The rise in pregnancies to women who themselves had congenital heart disease. (From Thompson JL, Kuklina EV, Bateman BT, et al. Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol 2015;126(2):350; with permission.)

system and place women with heart disease at increased risk of complications, including heart failure and death. Systematic assessment of pregnancy risk in these women, ideally before conception, is essential in optimizing maternal and fetal outcomes.4 The American College of Cardiology and American Heart Association have put forth comprehensive guidelines for management of adult congenital heart patients, including recommendations for appropriate transition of care from pediatric to adult providers.5 These guidelines call for a smooth handoff of the care of these patients to adult providers, and many centers now have adult congenital heart clinics staffed by pediatric and adult specialists. There is much to celebrate, but the job is not done yet. In this issue of Clinics in Perinatology, Drs Hamrick and Chanani have put together a state-of-the-art compilation of articles related to congenital heart disease covering the entire spectrum of malformations and their management; they point to areas ripe for further refinement and development. I want to thank the editors, authors, and our publishing team at Elsevier, led by Kerry Holland and Casey Jackson, for bringing together another superb issue of the Clinics in Perinatology for you. I also want to thank you, the loyal readers, for another successful year of learning together. We look forward to 2016 being another banner year for us! Lucky Jain, MD, MBA Emory University School of Medicine Department of Pediatrics Children’s Healthcare of Atlanta 2015 Uppergate Drive Atlanta, GA 30322, USA E-mail address: [email protected]

Foreword

REFERENCES

1. Thompson JL, Kuklina EV, Bateman BT, et al. Medical and obstetric outcomes among pregnant women with congenital heart disease. Obstet Gynecol 2015; 126(2):346–54. 2. Roos-Hesselink JW, Ruys PT, Johnson MR. Pregnancy in adult congenital heart disease. Curr Cardiol Rep 2013;15(9):401. 3. Bhatt AB, DeFaria Yeh D. Pregnancy and adult congenital heart disease. Cardiol Clin 2015;33(4):611–23. 4. Moghbeli N, Pare E, Webb G. Practical assessment of maternal cardiovascular risk in pregnancy. Congenit Heart Dis 2008;3(5):308–16. 5. Gerardin JF, Menk JS, Pyles LA, et al. Compliance with adult congenital heart disease guidelines: are we following the recommendations? Congenit Heart Dis 2015. http://dx.doi.org/10.1111/chd.12309.

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The Journey to Adult Congenital Heart Disease.

The Journey to Adult Congenital Heart Disease. - PDF Download Free
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