Description
The patients nobody was trained for
Adults living with repaired congenital heart disease now outnumber the paediatric congenital population. They are a consequence of successful paediatric surgery, and they present to general cardiologists who trained at a time when these patients did not survive to adulthood.
Specialist ACHD centres exist in a minority of countries. Everywhere else, the general cardiologist is the service.
Organised by what each repair fails from
That is the practical framing. A repaired tetralogy patient in their thirties develops pulmonary regurgitation and right ventricular dilatation. An atrial switch fails through systemic right ventricular dysfunction and atrial arrhythmia. A Fontan circulation attrits slowly through several distinct routes. Knowing the expected failure mode for each repair converts an intimidating patient into a manageable one.
The decisions that arrive without warning
Pregnancy, non-cardiac surgery, contraception and endocarditis prophylaxis get substantial chapters, because these are the questions that reach a general cardiologist urgently, from an obstetrician or an anaesthetist, and rarely allow time to read up first.
Also covered
Unrepaired shunts and Eisenmenger physiology, still common where childhood surgery was unavailable. Arrhythmia. Heart failure in an abnormal circulation. When referral to a specialist centre is genuinely necessary.
Suits
General cardiologists, obstetricians, anaesthetists, general physicians and cardiology trainees.
PDF, 313 pages, lifetime access, from CardiologyBooks.com.
The population cardiology was not trained for
Adults with congenital heart disease now outnumber children with it, and most are seen by clinicians whose training covered the paediatric repair and not the adult sequelae. This book covers the common repaired lesions as they present decades later: the failing systemic right ventricle, pulmonary regurgitation after tetralogy repair, coarctation restenosis and hypertension, Fontan circulation physiology and its late complications.
Pregnancy, arrhythmia, surgery and the transition
Separate chapters address the situations that generate urgent calls about adult congenital heart disease — pregnancy risk stratification and management, atrial arrhythmia in a scarred atrium, non-cardiac surgery and endocarditis prophylaxis, and the transition of care from paediatric to adult services, where patients are most often lost to follow-up. Referral thresholds to specialist centres are stated explicitly rather than left to judgement.
