Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertia...Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/-14.1 years were seen once or more in 12 clinics over the study period(September 1999 to January 2003). Diagnostic case mix consisted of 2.9%complex, 67.9%moderate and 29.2%minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations(mostly MRI) and 8%for intervention(with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.展开更多
Is it possible to advise either for or against prophylactic anticoagulation in patients following Fontan surgery? Certainly, the evidence suggests that thromboembolism is a major risk factor and it may therefore be co...Is it possible to advise either for or against prophylactic anticoagulation in patients following Fontan surgery? Certainly, the evidence suggests that thromboembolism is a major risk factor and it may therefore be considered reasonable to anticoagulate all patients. However, key information is missing regarding the safety and benefit from aspirin and warfarin treatment, as well as target international normalised ratio(INR) levels and timing of therapy. Consequently, if we are to subscribe to an evidence based approach, a blanket recommendation cannot be given. Nevertheless, if a high risk group is to be identified, patients with progressive right atrial dilatation and/or a history of atrial arrhythmia would appear, albeit anecdotally, to present the strongest case for prophylactic anticoagulation. Clearly, prospective controlled studies are required before definitive recommendations can be made.展开更多
文摘Congenital heart disease(CHD) affects approximately 250,000 adults in the UK. Most of these patients would benefit from specialized follow-up. However, there is at present a significant shortfall of specialized tertiary care expertise and facilities for this growing cardiovascular field in the UK and around the world. We aimed to report our experience with a joint adult CHD clinic run in a district general hospital with regular input from the local cardiology team and a visiting adult CHD specialist. In total, 148 patients aged 33.6+/-14.1 years were seen once or more in 12 clinics over the study period(September 1999 to January 2003). Diagnostic case mix consisted of 2.9%complex, 67.9%moderate and 29.2%minor cases of CHD. Twenty percent of patients visited the counterpart tertiary center for additional investigations(mostly MRI) and 8%for intervention(with no operative mortality). There was one death during the study period giving an overall mortality of 0.2%/year. Patients were referred to the clinic from tertiary centres, the local cardiology and paediatric clinics and with time from obstetric and community sources. Nonattendance rates were relatively low, comparing favourably with tertiary care. This model of joint care for the adult CHD patient at a general district hospital with regular onsite specialized input appears to be effective and highlights the need for additional resource allocation to provide optimal care for these patients. Our data may be useful in future planning for CHD services.
文摘Is it possible to advise either for or against prophylactic anticoagulation in patients following Fontan surgery? Certainly, the evidence suggests that thromboembolism is a major risk factor and it may therefore be considered reasonable to anticoagulate all patients. However, key information is missing regarding the safety and benefit from aspirin and warfarin treatment, as well as target international normalised ratio(INR) levels and timing of therapy. Consequently, if we are to subscribe to an evidence based approach, a blanket recommendation cannot be given. Nevertheless, if a high risk group is to be identified, patients with progressive right atrial dilatation and/or a history of atrial arrhythmia would appear, albeit anecdotally, to present the strongest case for prophylactic anticoagulation. Clearly, prospective controlled studies are required before definitive recommendations can be made.
