Journal articles on the topic 'Heart Surgery Patients Medical care'
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1
Sibagatullin, N. G., M. Kh Zakirzyanov, I. R. Yagafarov, I. R. Zakirov, E. V. Tenin, M. G. Khatypov, Z. Sh Ishmuratova, and N. G. Faskhutdinov. "Six-year results of the regional medical center department of cardiac surgery." Kazan medical journal 96, no. 3 (June 15, 2015): 285–94. http://dx.doi.org/10.17750/kmj2015-285.
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Aim. To summarize the experience of the first years of activity in the department of cardiac surgery of the regional medical center.Methods. 5549 patients with cardiovascular diseases were treated from December 2008 to December 2014, including 3041 patients who underwent surgeries, among them - 1585 vascular interventions, 1128 hearts surgeries. The study included patients operated on the heart and aortic arch, 238 of them had surgeries in 2014 [854 male (75.7%), 274 female (24.3%), aged 22 to 81 years (57.8±8.9)].Results. Number of performed surgeries was assessed to find out whether it matches with the population needs. For coronary heart disease, 880 patients underwent surgeries, 10 were operated for coronary heart disease complications, 132 - for heart valve disease, 16 - for congenital heart disease, 56 - for combined heart disease, 18 - for aortic aneurysms, 16 - for cardiac tumors, 3 for pulmonary embolism and aortic dissection (type 1). The number of heart surgery using cardiopulmonary bypass in recalculation per 1 million inhabitants in 2014 was 317. Thanks to the active work of the regional medical-diagnostic center, significant progress was made in timely identification and providing specialized care to patients with cardiovascular diseases to meet the population needs in high-tech medical care in the region.Conclusion. Evaluation of the study results reveals that the introduction of cardiac surgeries for cardiovascular diseases in the regional center promotes approximation of high-tech medical care to the population of remote regions, improves the quality of treatment in patients with cardiovascular conditions.
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Ashman, Zane, Elizabeth Lancaster, Nancy Satou, Richard J. Shemin, Jonathan R. Hiatt, and Peyman Benharash. "Acute Care Surgery in Heart Transplant Recipients." American Surgeon 79, no. 10 (October 2013): 973–76. http://dx.doi.org/10.1177/000313481307901003.
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Orthotopic heart transplantation (OHT) is the optimal treatment for end-stage heart failure. We reviewed our institutional experience between 2008 and 2012 with acute care surgery (ACS) consultations and procedures within 1 year of OHT in recipients bridged to transplantation with medical therapy (MT, n = 169), including intravenous inotropes, and ventricular assist devices (VADs, n = 74). In total, 28 consultations were required in 21 patients (9%) and 16 procedures were performed in 11 patients (5%). The interval from transplantation to consultation was shorter for the MT group (50 vs 82 days; P = 0.015), whereas the interval from consultation to operation was longer (5 vs 1 day; P = 0.03). Patients undergoing MT were more likely to require consultation for abdominal problems (88 vs 27%; P = 0.004). All but one of the seven ischemic/inflammatory abdominal problems occurred in the MT group. Complications occurred after five ACS procedures (31%) in two patients undergoing MT and three patients undergoing VAD. Mortality was 24 per cent with five deaths occurring within 30 days of ACS consultation and/or operation. In summary, this is one of the largest series of ACS problems in patients undergoing OHT bridged to transplant with MT or VAD. With similar incidence in MT and VAD groups, ACS consultations and operations are infrequent with high mortality and morbidity.
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Nikolaeva, I. E., R. R. Rayanova, L. V. Yakovleva, L. R. Shaybakova, D. V. Onegov, and I. M. Khabibullin. "Organization of specialized care for children with cardiovascular diseases at the republican heart center in Republic of Bashkortostan." Kazan medical journal 96, no. 4 (August 15, 2015): 633–35. http://dx.doi.org/10.17750/kmj2015-633.
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The organization of cardiologic and cardio surgical care for children and adolescents in Republican Heart Center of Republic of Bashkortostan is characterized. The hospital has a united block for providing specialized medical care. Departments of cardio surgery, pediatric cardiology and intensive care unit №1 are based on the same floor. The advantages of staged approach and continuity of care for children and adolescents with cardiovascular diseases is emphasized. Registers for prenatal diagnosis of congenital heart diseases (includes 7894 children and adolescents by December 31, 2012), for pulmonary hypertension are developed and used in the Republican Heart Center for timely cardio surgery in patients with congenital heart diseases. The main directions of medical care for children with cardiovascular diseases in Republic heart center are cardiac surgery of congenital heart diseases, pediatric cardiology, radiosurgery of congenital heart diseases, emergency cardiology and cardiac surgery, and neonatal cardiac surgery. 4500 cardiovascular surgeries are performed annually, including 398 on children aged 0-17 years, among them 224 on assisted circulation. Department of cardio surgery annually performs about 100 surgeries on infant patients with «critical» congenital heart diseases, contributing up to 35% of all children who underwent surgery, including 30 surgeries per year on newborns. The outpatient clinics examines over 15 thousand children per year. The basis of the successful maintaining the public health is good teamwork of highly specialized professionals in the atmosphere of a clear motivation, enthusiasm and high morals.
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Zoumpoulakis, M., F. Anagnostou, S. Dalampiras, L. Zouloumis, and C. Pliakos. "Infective Endocarditis Prophylaxis in Patients Undergoing Oral Surgery." Balkan Journal of Dental Medicine 20, no. 1 (March 1, 2016): 5–14. http://dx.doi.org/10.1515/bjdm-2016-0001.
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SummaryInfective endocarditis (IE), an infection of the endocardium that usually involves the valves and adjacent structures, may be caused by a wide variety of bacteria and fungi that entered the bloodstream and settled in the heart lining, a heart valve or a blood vessel. The IE is uncommon, but people with some heart conditions have a greater risk of developing it. Despite advances in medical, surgical, and critical care interventions, the IE remains a disease that is associated with considerable morbidity and mortality. Hence, in order to minimize the risk of adverse outcome and achieve a yet better management of complications, it is crucial to increase the awareness of all the prophylactic measures of the IE.For the past 50 years, the guidelines for the IE prophylaxis have been under constant changes. The purpose of this paper is to review current dental and medical literature considering the IE prophylaxis, including the new and updated guidelines from the American Heart Association (AHA, 2007 and 2015), the National Institute for Health and Clinical Excellence (NICE, 2015), the European Society of Cardiology (ESC, 2009 and 2015) and the British Society for Antimicrobial Chemotherapy (BSAC, 2006).
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Siromakha, S. O., Yu V. Davydova, A. O. Tarnavska, N. I. Volkova, and N. B. Nakonechna. "Strategy of Medical Care for Pregnant Women with Congenital Heart Disease." Ukrainian journal of cardiovascular surgery, no. 1 (42) (March 16, 2021): 64–69. http://dx.doi.org/10.30702/ujcvs/21.4203/s015064-069/082.8.
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Grown-up congenital heart (GUCH) is a global challenge nowadays. The strategy of medical care for GUCH women dur-ing pregnancy, childbirth and the postpartum period is a topic of active discussion in the expert community. These patients have significantly increased risk of maternal and perinatal loss. A national obstetric cardiology and cardiac surgery multi-disciplinary team (OCCS) established in academic institutions in 2013 has provided medical support to 896 GUCH pregnant women over the last 7 years. In total, GUCH patients accounted for 36% of the cohort of all the examined pregnant women. Of these, 474 (53%) were primigravid. The mean age of the patients at the time of the first visit was 27.3 ± 5.7 years. Patients with uncorrected CHD accounted for 66.2% (n = 593), and 33.8% (n = 303) of pregnant women had undergone correction, including hemodynamic correction of complex CHD in 5 patients. Risk stratification was performed using several scores (mWHO, ZAHARA, CARPREG) for the comprehensive assessment of cardiovascular risk and prediction of pregnancy, deliv-ery, and postpartum period course. 82 patients were classified as having high cardiovascular risk (CVR) after the stratifica-tion. They needed admission to the cardiac surgery facility to receive different types of medical care. There were 2 (2.4%) cases of maternal loss and 3 (3.8%) cases of adverse perinatal outcomes in this group of patients. The article presents the algorithms for multidisciplinary care strategy choice in GUCH pregnant women with high CVR and their routing principles developed by the OCCS. These algorithms significantly reduced adverse outcomes of pregnancy and childbirth in this group of patients. Long-term results were evaluated in 69 patients (86.3%). The follow-up period ranged from 1 to 91 months, on average 34.4 ± 23.6 months. There were no long-term maternal losses or repeated cardiac surgeries. There was one case of unexplained death of a child 8 months after birth. The strategy of multidisciplinary medical care of a high-class GUCH pregnant woman should be personalized depending on the clinical data and in accordance with the ESC 2018 guidelines.
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Adrian, J., D. P. Crankshaw, J. W. G. Tiller, and R. O. Stanley. "Affective, Cognitive and Subjective Changes in Patients Undergoing Cardiac Surgery — a Preliminary Report." Anaesthesia and Intensive Care 16, no. 2 (May 1988): 144–49. http://dx.doi.org/10.1177/0310057x8801600203.
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Neuropsychiatric change following open-heart surgery has been investigated and emboli proposed as a major causative factor. However, few studies have thoroughly evaluated patients’ status prior to surgery. The subjective experiences and neuropsychological status of five open-heart surgery patients was documented both pre- and postoperatively. It was found that prior to surgery patients presented with a wide range of cognitive and emotional problems, some of which were exacerbated by surgery. In particular psychomotor slowing was observed and persisted at six weeks following surgery. This report highlights the importance of conducting preoperative assessments in research which aims to evaluate the effects of different medical procedures on neuropsychiatric functioning.
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Massetti, Massimo, and Giovanni Alfonso Chiariello. "The extended heart: cardiac surgery serving more hospitals." European Heart Journal Supplements 22, Supplement_E (March 24, 2020): E91—E95. http://dx.doi.org/10.1093/eurheartj/suaa069.
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Abstract The Heart Team is becoming ever more central in delivering cardiovascular care, embodying a modern aspect of medical practice, designed to place the patient at the ‘center’ of a team with different specialists, all contributing to the definition of the most appropriate therapeutic actions. We prospectively analyzed 200 consecutive patients (2015–2017). Patients were evaluated independently by a cardiologist and a cardiac surgeon, each deciding the most appropriate therapeutic action. At a later time, the same patient, was evaluated by the Heart Team. For the first 100 patients the rate of concurrence between cardiologist and cardiac surgeon as well as among each specialist and the Heart Team, was relatively low (51 and 42% respectively). For the following 100 patients the concurrence rate was significantly higher (75 and 70% respectively). The systematic and collegial discussion of the patients in the contest of the Heart Team, steered toward an evolution of each specialist in the group settings. The Electronic Heart Team (e-Heart Team) employing video conference support, applied to the first 65 patients with promising results, represent a further advancement in the delivery of care, by reducing the distance from the ‘Hub’ center, and the specialist in the ‘Spoke’ facility, who from simple source of the patient, now becomes an essential part of the therapeutic decision process. The Heart Team environment can deeply affect patients management and improve treatment results, by sharing the expertise and overcoming the limitations of the individual disciplines, thus reaching the common goal of the patient's best available treatment.
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Putra Gofur, Nanda Rachmad, Aisyah Rachmadani Putri Gofur, Soesilaningtyas Soesilaningtyas, Rizki Nur Rachman Putra Gofur, Mega Kahdina, and Hernalia Martadila Putri. "Management Congenital Heart Disease Surgery during COVID-19: A Review Article." Cardiology Research and Reports 4, no. 2 (March 11, 2022): 01–03. http://dx.doi.org/10.31579/2692-9759/040.
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Introduction: Congenital heart disease is a form of heart abnormality that has been acquired since the newborn. The clinical course of this disorder varies from mild to severe. In mild forms, there are often no symptoms, and no abnormalities are found on clinical examination. Whereas in severe CHD, symptoms have been visible since birth and require immediate action. Generally, the management of congenital heart disease includes non-surgical management and surgical management. Non-surgical management includes medical management and interventional cardiology. Medical management is generally secondary as a result of complications from heart disease itself or due to other accompanying disorders. In this case, the goal of medical therapy is to relieve symptoms and signs in addition to preparing for surgery. The duration and method of administration of drugs depend on the type of disease at hand. Discussion: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which led to the coronavirus disease 2019 (COVID-19) pandemic, was initially reported in Wuhan, China in December, 2019. The rapid rise in the number of cases worldwide led to hospitals struggling to cope with the sudden influx of patients. This has had a ripple effect on other parts of health care as manpower and supplies needed to be reallocated. Within cardiology, this has led to outpatient appointments and elective surgeries being reduced and/or postponed. COVID-19 appears to have a complicated relationship with cardiovascular system, as studies have suggested cardiovascular diseases increase disease severity and mortality rates in those who are infected. However, the virus has also been shown to cause cardiovascular complications such as acute myocardial injury, heart failure, and arrhythmia. Conclusion: Coronavirus may also cause myocardial injury via the cytokine storm that occurs in response to a possible large immune response during the infection. Cardiac involvement such as right ventricular failure and congestion can either be a result of respiratory distress or direct cardiac injury caused by the virus, as suggested by the raised cardiac troponin I in critical patients compared to non-critical patients.
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Zaripov, D., Zh Ashimov, and S. Shakhnabieva. "Relevance of Congenital Heart Defects in the Kyrgyz Republic." Bulletin of Science and Practice 6, no. 1 (January 15, 2020): 91–96. http://dx.doi.org/10.33619/2414-2948/50/09.
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Article is devoted to the analysis of material on the relevance of congenital heart defects in the Kyrgyz Republic. The main groups of factors affecting the aetiology of congenital heart defects have been identified. Assessment of social, medical and legal provisions that have developed in cardiac surgery at the present stage dictates the need for monitoring before and after surgical correction, which can provide an improvement in the mechanism for providing medical care to patients. Based on the analysis, measures are proposed to improve the quality of medical care for this category of patients.
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Bogachevskaya, Svetlana A., A. N. Bogachevskiy, and N. A. Kapitonenko. "The organization of high-tech medical care of patients with ischemic heart diseasein the Far East federal region in 2004-2013." Health Care of the Russian Federation 60, no. 5 (May 24, 2019): 251–59. http://dx.doi.org/10.18821/0044-197x-2016-60-5-251-259.
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To determine both perspectives of development of high-tech medical care in Russia and actuality of possible restructuring of system of cardio-surgery care of population it is appropriate to evaluate condition of surgical and intervention treatment of ischemic heart disease i the country and regions using the example of the Far East federal region. The analyzed indices were calculated for 100 000 of adult population. In Russia, during last decade, total common morbidity of ischemic heart disease increased up to 13.25±0,11% (n ± m) and primary morbidity factually doubled. In the Far East region indices increased up to 21,34 ± 0,13% and 67,33 ± 0,15% correspondingly. In Russia, the number of patients after coronary bypass surgery in increased up to 3.3 times (percentage of patients after ischemic heart disease surgery decreased on 42.5%) and number of patients with endovascular correction increased up to 7.8 times (their percentage increased up to 37.2%). In the Far East region increasing of coronary bypass surgery increased in 12.4 times, endovascular procedures - in 32.1 times. In Russia from 2005 lethality during direct myocardium re-vascularization surgery decreased on 21.6% and in case of endovascular interventions increased up to 2.1-2.9 times, including planned operations. The dynamics of most analyzed indices corresponds to international tendencies. However, the level of coronary surgery in Russia is still significantly lower than in the developed countries of Europe and America. In the Far East region, in 2013 situation with coronary surgery looks more reassuring than in 2004-2005 when it factually stopped developing. The health care authorities are to implement in the regions more elaborated analysis ofepidemiological indices with the purpose to develop effective activities concerning indices' amelioration; to standardize evaluation of lethality in case of surgery intervention; to adjust national standards of medical care under ischemic heart disease according international standards.
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Devald, I. V., and E. V. Karakulova. "MEDICO-DEMOGRAPHIC PORTRAIT OF A PATIENT WITH ISCHEMIC HEART DISEASE AND SURGICAL INTERVENTION PROFILED AS CARDIOVASCULAR SURGERY." Siberian Medical Journal 33, no. 3 (November 28, 2018): 111–17. http://dx.doi.org/10.29001/2073-8552-2018-33-3-111-117.
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Aim: the aim of the study was to analyze the relationships of social, demographic and medical characteristics in patients with ischemic heart disease in case of high-technological medical care type profiled as «Cardiovascular surgery».Material and Methods. The material of the study was database of patients hospitalized in Cardiology Research Institute, Tomsk NRMC (Tomsk, Russia). Methods of descriptive statistics and nonparametric methods for testing statistical hypotheses were used.Results. As a result of the study, the differences in age- and sex-related structures, employment, and employability of patients were identified. Clinical diagnoses and durations of hospitalizing were analyzed depending on sex, age and type of high-technological medical care. Elucidation of these differences allowed us to identify two main models of patients with radical surgical correction of ischemic heart disease.Conclusion. Elucidation of these differences allowed us to identify two main models of patients with radical surgical correction of ischemic heart disease. These models may be used for clinical and economic analysis of high-technological medical aid based on the method of modeling.
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Vogt, Paul R., Gennadiy Grigorevich Khubulava, and Sergey Pavlovich Marchenko. "EurAsia Heart - international cooperation in cardiovascular surgery." Pediatrician (St. Petersburg) 5, no. 4 (December 15, 2014): 127–31. http://dx.doi.org/10.17816/ped54127-131.
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Cardiovascular diseases are the major cause of death in neonates, children, adolescents and adults. Untreated congenital heart disease is the major cause of death worldwide in children younger than five years of age, exceeding the combined death rate caused, e.g. by malaria, tuberculosis or HIV [6]. In many developing countries, life expectancy is limited to an average of 58 to 64 years of age [1, 2]. In addition quality of life is markedly reduced while the number of disabled patients and patients depending from social welfare is steadily increasing. The major cause is undiagnosed and untreated cardiovascular diseases. Eighty percent of all cardiovascular deaths worldwide occur in developing countries [3]. Cardiology and cardiovascular surgery are powerful tools to increase the life expectancy, to improve and normalize the quality of life, to preserve patients able to work and to reduce the overall health care costs as well as costs for social welfare for those otherwise disabled by chronic cardiovascular diseases. Developing countries invest in cardiology and cardiovascular surgery. However, the establishment of a cardiovascular centre is a challenging task. The problem is that several specialties have to be developed simultaneously: cardiology, cardiac surgery, perfusion techniques, anaesthesia, intensive care as well as postoperative medical treatment - for adults and for children. The attractiveness of EurAsia Heart Foundation allowed establishing numerous international co-operations with excellent institutions, interested and engaged in teaching and education abroad.
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Xue, Wei, Zhang Xinlan, and Zheng Xiaoyan. "Effectiveness of early cardiac rehabilitation in patients with heart valve surgery: a randomized, controlled trial." Journal of International Medical Research 50, no. 7 (July 2022): 030006052110443. http://dx.doi.org/10.1177/03000605211044320.
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Objective Complications of heart valve surgery lead to physical inactivity and produce harmful effects. This study aimed to investigate the role of a cardiac rehabilitation program and its long-term effect in patients after heart valve surgery. Methods We performed a single-blind, randomized, controlled trial. Patients with heart valve surgery were randomly assigned to receive early cardiac rehabilitation (intervention group, 44 patients) or the usual care (control group, 43 patients). The intervention group performed sitting, standing, and walking exercises, followed by endurance training. The control group received usual care and did not engage in any physical activity. Physical function was assessed by the Short Physical Performance Battery (SPPB) and other measurement tools. Results The intervention group showed a significant beneficial effect regarding physical capacity as shown by the SPPB and the 6-minute walking test at hospital discharge, and a better long-term effect was achieved at 6 months compared with the control group. An improvement in physical function (e.g., the SPPB) after hospital discharge predicted follow-up mortality (odds ratio = 0.416, 95% confidence interval: 0.218–0.792). Conclusion Early cardiac rehabilitation appears to be an effective approach to improve the physical function and survival of patients with heart valve surgery.
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Willems, Ruben, Philip Tack, Katrien François, and Lieven Annemans. "Direct Medical Costs of Pediatric Congenital Heart Disease Surgery in a Belgian University Hospital." World Journal for Pediatric and Congenital Heart Surgery 10, no. 1 (January 2019): 28–36. http://dx.doi.org/10.1177/2150135118808747.
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Objectives: The recent trend to optimize the efficiency of health-care systems requires objective clinical and economic data. European data on the cost of surgical procedures to repair or palliate congenital heart disease in pediatric patients are lacking. Methods: A single-center study was conducted. Bootstrap analysis of variance and bootstrap independent t test assessed the excess direct medical costs associated with minor and major complications in nine surgical procedure types, from a health-care payer perspective. Generalized linear models with log-link function and inverse Gaussian family were used to determine associated covariates with the total hospitalization cost. Descriptive statistics show the repartition between out-of-pocket expenditures and reimbursed costs. Results: Four hundred thirty-seven patients were included. Mean hospitalization costs ranged from €11,106 (atrial septal defect repair) to €33,865 (Norwood operation). Operations with major complications yielded excess costs compared to operations with no complications, ranging from €7,105 (+65.2%) for a truncus arteriosus repair to €27,438 (+251.7%) for a tetralogy of Fallot repair. Differences in costs were limited between operations with minor versus no complications. Age at procedure, intensive care unit stay, procedure risk category, reintervention, and postoperative mechanical circulatory support were associated with higher total hospitalization costs. Out-of-pocket expenditures represented 6% of total hospitalization costs. Conclusion: Operations with major complications yield excess costs, compared to operations with minor or no complications. Cost data and attribution are important to improve clinical practice in a cost-effective manner. The health-care system benefits from strategies and technological advancements that have an impact on modifiable cost-affecting parameters.
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Anton, Kristin. "Challenges Caring for Adults With Congenital Heart Disease in Pediatric Settings: How Nurses Can Aid in the Transition." Critical Care Nurse 36, no. 4 (August 1, 2016): e1-e8. http://dx.doi.org/10.4037/ccn2016131.
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As surgery for complex congenital heart disease is becoming more advanced, an increasing number of patients are surviving into adulthood, yet many of these adult patients remain in the pediatric hospital system. Caring for adult patients is often a challenge for pediatric nurses, because the nurses have less experience and comfort with adult care, medications, comorbid conditions, and rehabilitation techniques. As these patients age, the increased risk of complications and comorbid conditions from their heart disease may complicate their care further. Although these patients are admitted on a pediatric unit, nurses can aid in promoting their independence and help prepare them to transition into the adult medical system. Nurses, the comprehensive medical teams, and patients’ families can all effectively influence the process of preparing these patients for transition to adult care.
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De Marco, Teresa, and Kanu Chatterjee. "Refractory Heart Failure: A Therapeutic Approach." Journal of Intensive Care Medicine 11, no. 3 (May 1996): 121–48. http://dx.doi.org/10.1177/088506669601100301.
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Optimal “triple therapy” for patients with chronic congestive heart failure (CHF) includes diuretics, digoxin, and either angiotensin-converting enzyme inhibitors or hydralazine plus nitrates. Refractory CHF is defined as symptoms of CHF at rest or repeated exacerbations of CHF despite “optimal” triple-drug therapy. Most patients with refractory CHF require hemodynamic monitoring and treatment in the intensive care unit. If easily reversible causes of refractory CHF cannot be identified, then more aggressive medical and surgical interventions are necessary. The primary goal of intervention is to improve hemodynamics to palliate CHF symptoms and signs (i.e., dyspnea, fatigue, edema). Secondary goals include improved vital organ and tissue perfusion, discharge from the intensive care unit, and, in appropriate patients, bridge to cardiac transplantation. Medical interventions include inotropic resuscitation (e.g., adrenergic agents, phosphodiesterase inhibitors, allied nonglycoside inodilators), load resuscitation (e.g., afterload and preload reduction with nitroprusside or nitroglycerin; preload reduction with diuretics and diuretic facilitators, such as dopaminergic agents or ultrafiltration), and electrical resuscitation (e.g., prevention of sudden death, correction of new or rapid atrial fibrillation, or dual chamber pacing in the setting of relative prolongation of the PR interval and diastolic mitral/tricuspid regurgitation). Surgical interventions are temporizing (e.g., intra-aortic balloon pump and other mechanical assist devices) or definitive (e.g., coronary artery revascularization, valvular surgery, and cardiac transplantation). Although these interventions may improve immediate survival in the short term, only coronary artery revascularization and cardiac transplantation have been shown to improve long-term survival.
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Karlsson, Ann-Kristin, Mats Johansson, and Evy Lidell. "Fragility—The Price of Renewed Life. Patients Experiences of Open Heart Surgery." European Journal of Cardiovascular Nursing 4, no. 4 (December 2005): 290–97. http://dx.doi.org/10.1016/j.ejcnurse.2005.03.009.
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Background: Open heart surgery often implies a threat to life and is associated with fear and anxiety. It is also a strong encroachment on body and integrity and adjusting life afterwards could be difficult. Despite improvements in treatment the patients' reactions appear to be unchanged. Introducing a lifeworld perspective would supply a different kind of knowledge based upon the patients' own experiences coloured by their linguistic usage and bodily expressions. Aim: The aim of this study was to describe patients' experiences of open heart surgery in a lifeworld perspective. Method: Fourteen patients treated with coronary artery bypass surgery and/or heart valve operation were in-depth interviewed in 2003. The phenomenological method was used for the interviews as well as for the analysis. The informants reflected on their experiences of the illness, meetings with health care, family relations and wishes for the future. Findings: The essence of the phenomenon was fragility. Fragility was understood through the following categories: distance, uncertainty, vulnerability, reliance and gratitude. Conclusions: Patients want to be treated as unique individuals. They ask for more dialogues with the staff. Awareness of their supposed lifelong fragility implies that health care staff acquires an open and holistic approach.
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Schoormans, Dounya, Ellen M. A. Smets, Ronald Zwart, Mirjam A. G. Sprangers, Tonny H. M. Veelenturg, Bas A. J. M. de Mol, Mark G. Hazekamp, et al. "Peri-operative care in adults with congenital heart disease: room for improvement in after care." Cardiology in the Young 23, no. 4 (October 2, 2012): 540–45. http://dx.doi.org/10.1017/s1047951112001254.
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AbstractBackgroundPatient satisfaction with care has received little attention within the field of congenital heart disease. Our objective was to examine patient satisfaction with the care received when undergoing open-heart surgery in order to identify the best and worst aspects of peri-operative care. Moreover, we examined whether having contact with a specialised nurse in addition to usual care is associated with higher patient satisfaction levels.MethodsPatient satisfaction was measured by the Satisfaction with Hospital Care Questionnaire, evaluating nine aspects of care by answering individual items and giving overall grades. A top 10 of the best and worst items was selected. Linear regression analyses were used to examine the relationship between having contact with a specialised nurse and patient satisfaction (9 grades), independent of patient characteristics – sex, age, educational level, and health status.ResultsData were available for 75 patients. Grades ranged from 6.74 for “discharge and after care” to 8.18 for “medical care”. In all, 21% of patients were dissatisfied with the clarity of the information about lifestyle adjustments given by the surgeon. However, patients who had contact with a specialised nurse were more satisfied with the provided information (B-coefficient is 0.497, p-value is 0.038), independent of patient characteristics.ConclusionsPatients were satisfied with the received care, although there is room for improvement, especially in discharge and after care and the clarity of the information provided by the surgeon. This gap in care can be compensated for by specialised nurses, as patients who were counselled by a specialised nurse were more satisfied with the provided information.
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Karol, Dalia. "The Power of Global Surgery: A Medical Student’s Experience At Save A Child’s Heart (SACH)." University of Ottawa Journal of Medicine 8, no. 1 (May 7, 2018): 75–77. http://dx.doi.org/10.18192/uojm.v8i1.2351.
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This elective report provides an overview of the experience of a 1st year medical student completing a global pediatric cardiac surgery elective at Save A Childs Heart (SACH), an Israeli Non-Governmental Organization (NGO). SACH provides life saving cardiac surgery to children from developing countries who would otherwise not have access to care. Children are screened in their home countries, and brought to Israel for these complex surgical procedures. This elective is unique, as it exposes medical students to leading experts in cardiac surgery, cardiology, pediatric ICU, as well as international residents and international patients.
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Cleary, John P., Annie Janvier, Barbara Farlow, Meaghann Weaver, James Hammel, and John Lantos. "Cardiac Interventions for Patients With Trisomy 13 and Trisomy 18: Experience, Ethical Issues, Communication, and the Case for Individualized Family-Centered Care." World Journal for Pediatric and Congenital Heart Surgery 13, no. 1 (December 17, 2021): 72–76. http://dx.doi.org/10.1177/21501351211044132.
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This report is informed by the themes of the session Trisomy 13/18, Exploring the Changing Landscape of Interventions at NeoHeart 2020—The Fifth International Conference of the Neonatal Heart Society. The faculty reviewed the present evidence in the management of patients and the support of families in the setting of trisomy 13 and trisomy 18 with congenital heart disease. Until recently medical professionals were taught that T13 and 18 were “lethal conditions” that were “incompatible with life” for which measures to prolong life are therefore ethically questionable and likely futile. While the medical literature painted one picture, family support groups shared stories of the long-term survival of children who displayed happiness and brought joy along with challenges to families. Data generated from such care shows that surgery can, in some cases, prolong survival and increase the likelihood of time at home. The authors caution against a change from never performing heart surgery to always—we suggest that the pendulum of intervention find a balanced position where all therapies including comfort care and surgery can be reviewed. Families and clinicians should typically be supported and empowered to define the best care for their children and patients. Key concepts in communication and case vignettes are reviewed including the importance of supportive relationships and the fact that palliative care may serve as an additional layer of support for decision-making and quality of life interventions. While cardiac surgery may be beneficial in some cases, surgery should not be the primary focus of initial family education and support.
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Roberts, Gregory, Rasha Razooqi, and Stephen Quinn. "Comparing Usual Care With a Warfarin Initiation Protocol After Mechanical Heart Valve Replacement." Annals of Pharmacotherapy 51, no. 3 (October 26, 2016): 219–25. http://dx.doi.org/10.1177/1060028016676830.
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Background: The immediate postoperative warfarin sensitivity for patients receiving heart valve prostheses is increased. Established warfarin initiation protocols may lack clinical applicability, resulting in dosing based on clinical judgment. Objective: To compare current practice for warfarin initiation with a known warfarin initiation protocol, with doses proportionally reduced to account for the increased postoperative sensitivity. Methods: We compared the Mechanical Heart Valve Warfarin Initiation Protocol (Protocol group) with current practice (clinical judgment—Empirical group) for patients receiving mechanical heart valves in an observational before-and-after format. End points were the time to achieve a stable therapeutic international normalized ratio (INR), doses held in the first 6 days, and overanticoagulation in the first 6 days. Results: The Protocol group (n = 37) achieved a stable INR more rapidly than the Empirical group (n = 77; median times 5.1 and 8.7 days, respectively; P = 0.002). Multivariable analysis indicated that the Protocol group (hazard ratio [HR] = 2.22; P = 0.005) and men (HR = 1.76; P = 0.043) more rapidly achieved a stable therapeutic INR. Age, serum albumin, amiodarone, presence of severe heart failure, and surgery type had no impact. Protocol patients had fewer doses held (1.1% vs 10.1%, P < 0.001) and no difference in overanticoagulation (2.7% vs 9.1%, P = 0.27). Conclusion: The Mechanical Heart Valve Warfarin Initiation Protocol provided a reliable approach to initiating warfarin in patients receiving mechanical aortic or mitral valves.
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Kovacevic, Pavle, Bogoljub Mihajlovic, Lazar Velicki, Aleksandar Redzek, Vladimir Ivanovic, and Nikola Komazec. "Ministernotomy: A preliminary experience in heart valve surgery." Vojnosanitetski pregled 68, no. 5 (2011): 405–9. http://dx.doi.org/10.2298/vsp1105405k.
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Background/Aim. The last decade of the 20th century brought up a significant development in the field of minimally invasive approaches to the valvular heart surgery. Potential benefits of this method are: good esthetic appearance, reduced pain, reduction of postoperative hemorrhage and incidence of surgical site infection, shorter postoperative intensive care units (ICU) period and overall in-hospital period. Partial upper median sternotomy currently presents as a state-of-the art method for minimally invasive surgery of cardiac valves. The aim of this study was to report on initial experience in application of this surgical method in the surgery of mitral and aortic valves. Methods. The study was designed and conducted in a prospective manner and included all the patients who underwent minimally invasive cardiac valve surgery through the partial upper median sternotomy during the period November 2008 - August 2009. We analyzed the data on mean age of patients, mean extubation time, mean postoperative drainage, mean duration of hospital stay, as well as on occurance of postoperative complications (postoperative bleeding, surgical site infection and cerebrovascular insult). Results. During the observed period, in the Institute for Cardiovascular Diseases of Vojvodina, Clinic for Cardiovascular Surgery, 17 ministernotomies were performed, with 14 aortic valve replacements (82.35%) and 3 mitral valve replacements (17.65%). Mean age of the patients was 60.78 ? 12.99 years (64.71% males, 35.29% females). Mean extubation time was 12.53 ? 8.87 hours with 23.5% of the patients extubated in less than 8 hours. Mean duration of hospital stay was 12.35 ? 10.17 days (in 29.4% of the patients less than 8 days). Mean postoperative drainage was 547.06 ? 335.2 mL. Postoperative complications included: bleeding (5.88%) and cerebrovascular insult (5.88%). One patient (5.88%) required conversion to full sternotomy. Conclusion. Partial upper median sternotomy represents the optimal surgical method for the interventions on the whole ascendant aorta (including aortic valve) and mitral valve through the roof of the left atrium, with a few significant advantages compared to the full sternotomy surgical approach.
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Magyar, Matthew, Allyson Shephard, Pat Bedard, Ken Tang, Gyaandeo Maharajh, and Nisha Thampi. "Getting to the Heart of the Matter: Epidemiology of Surgical Site Infections Following Open Heart Surgery in Children." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s239—s240. http://dx.doi.org/10.1017/ice.2020.796.
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Background: Surgical site infections (SSIs) following open heart surgery involving cardiopulmonary bypass (CPB) among pediatric patients are healthcare-associated infections associated with significant morbidity and mortality. At a pediatric acute-care facility, an increase in SSI incidence prompted an epidemiologic review. We describe the incidence of cardiac SSIs at our hospital; we identified risk factors and areas of practice variation to inform improvement initiatives. Methods: SSI cases following CPB at our hospital have been identified through routine surveillance using NHSN definitions since January 2016. An increase in cases was noted in mid-2018, prompting a common cause analysis with stakeholders across the preoperative, intraoperative, and postoperative care continuum. Areas of practice variability were identified, and an epidemiologic review was performed to determine risk factors among cases compared to noncases between January 2016 and August 2018. The rate of SSIs and 95% confidence intervals were estimated, and univariate logistic regressions were fitted to estimate unadjusted odds ratios (ORs) for the association between each of the predetermined preoperative, intraoperative, and postoperative factors and developing an SSI. Results: Overall, 139 patients underwent surgery involving CPB between January 1, 2016, and August 31, 2018. Preoperative bathing was infrequently documented (9% among cases vs 5% among noncases; P = .56). Operating room observations identified frequent door openings and equipment crowding. Moreover, 11 patients (7.9%) developed a cardiac SSI, with 6 (14.3%) occurring in the first 8 months of 2018 (P = .067). There were no predominant pathogens; 3 of 11 cases were associated with methicillin-susceptible Staphylococcus aureus. Also, 9 cases were classified as deep incisional or organ-space SSI. Each hour increase in total CPB duration was associated with a 63% increase in odds of developing an SSI (OR, 1.626; 95% CI, 1.041–2.539). Each additional day of intubation (OR, 2.400; 95% CI, 1.203–4.788) and peritoneal dialysis (OR, 1.767; 95% CI, 1.070–2.919) during the first 3 days postoperatively were also associated with increased SSI risk. Postoperative documentation of wound assessment occurred in 60% of patients, with no difference between cases and noncases (55% vs 67%; P = .42). Conclusions: Using a mixed-methods approach, preoperative bathing, increased operating room traffic, and postoperative care around wounds and invasive devices were identified as areas of improvement toward safer surgical care. Although no unique organism or process explained the increased rate, determining risk factors and areas of practice variability through stakeholder engagement provided insight into opportunities to prevent SSIs.Funding: NoneDisclosures: None
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Siromakha, S. O., Iu V. Davydova, and V. I. Kravchenko. "Bicuspid Aortic Valve and Pregnancy." Ukrainian Journal of Cardiovascular Surgery, no. 2 (43) (June 18, 2021): 49–55. http://dx.doi.org/10.30702/ujcvs/21.4306/s028049-055/126.5_618.3.
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Bicuspid aortic valve (BAV) is the most common congenital heart disease. Severe stenosis of BAV and its combination with aortic pathology can cause significant adverse maternal and perinatal consequences. The optimal strategy for medical care of pregnant women with BAV has not been fully elucidated and requires further research. This paper presents 7.5 years of work experience of a multidisciplinary team of experts in obstetric cardiology and cardiac surgery in the medical care of pregnant women with BAV and co-existing pathology of the heart and aorta. The experience is based on modern international guidelines, our own research efforts and hospital protocols. Primary expert cardiac screening of 2,469 pregnant women revealed 4.3% of patients (n=106) with BAV. The choice of the strategy for their care was personalized and based on the degree of BAV lesions, any concomitant pathology of the heart and aorta, symptoms and life-threatening conditions. The article analyzes the experience of medical care of pregnant patients with BAV bearing high cardiovascular risk (n=24), presents indications for a certain type of medical care, method and place of birth before cardiac surgery during pregnancy. The types and optimal time for performing interventions during pregnancy and the postpartum period were discussed. Perinatal losses (n=3) were analyzed. The chosen strategy is effective, as evidenced by the absence of negative maternal consequences in the immediate and long-term follow-up period.
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Lee, Cheul, and Jae Young Lee. "Utility of three-dimensional printed heart models for education on complex congenital heart diseases." Cardiology in the Young 30, no. 11 (November 2020): 1637–42. http://dx.doi.org/10.1017/s1047951120003753.
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AbstractObjective:The objective of this study was to evaluate the feasibility and effects of education on complex congenital heart diseases using patient-specific three-dimensional printed heart models.Methods:Three-dimensional printed heart models were created using computed tomography data obtained from 11 patients with complex congenital heart disease. Fourteen kinds of heart models, encompassing nine kinds of complex congenital heart disease were printed. Using these models, a series of educational hands-on seminars, led by an experienced paediatric cardiac surgeon and a paediatric cardiologist, were conducted for medical personnel who were involved in the care of congenital heart disease patients. Contents of the seminars included anatomy, three-dimensional structure, pathophysiology, and surgery for each diagnosis. Likert-type (10-point scale) questionnaires were used before and after each seminar to evaluate the effects of education.Results:Between November 2019 and June 2020, a total of 16 sessions of hands-on seminar were conducted. The total number of questionnaire responses was 75. Overall, participants reported subjective improvement in understanding anatomy (4.8 ± 2.1 versus 8.4 ± 1.1, p < 0.001), three-dimensional structure (4.6 ± 2.2 versus 8.9 ± 1.0, p < 0.001), pathophysiology (4.8 ± 2.2 versus 8.5 ± 1.0, p < 0.001), and surgery (4.9 ± 2.3 versus 8.8 ± 0.9, p < 0.001) of the congenital heart disease investigated.Conclusions:The utilisation of three-dimensional printed heart models for education on complex congenital heart disease was feasible and improved medical personnel’s understanding of complex congenital heart disease. This education tool may be an effective alternative to conventional education tools for complex congenital heart disease.
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West, Robert. "Cardiac rehabilitation of older patients." Reviews in Clinical Gerontology 13, no. 3 (August 2003): 241–55. http://dx.doi.org/10.1017/s0959259804001066.
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Rehabilitation is a necessary step in the process of recovery from most serious illness and from many clinical interventions. The nature of rehabilitation, and the form of any programme of rehabilitation provided to help patients with this process, depends greatly on patient, illness, treatment or intervention, co-morbidity and on the availability of appropriate services. Heart disease is the leading cause of death in most developed countries and acute myocardial infarction (MI) is a major cause of acute medical admissions to hospitals, and revascularization by coronary artery bypass graft surgery (CABG) is a leading surgical intervention. Both MI and CABG involve a day or more in intensive care followed by several days recuperation in hospital. There is a fairly obvious case for rehabilitation for patients surviving the truly life-threatening experience of MI (20% sudden deaths and a further 10% die within 24 hours of onset of pain), and for patients following the major ‘trauma’ of open heart surgery (operative mortality about 1%). The specific needs of these two groups may differ because their experiences differ; one medical the other surgical, and, possibly more significantly, one unexpected, the other planned.
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Doumouras, Aristithes G., Jorge A. Wong, J. Michael Paterson, Yung Lee, Branavan Sivapathasundaram, Jean-Eric Tarride, Lehana Thabane, Dennis Hong, Salim Yusuf, and Mehran Anvari. "Bariatric Surgery and Cardiovascular Outcomes in Patients With Obesity and Cardiovascular Disease:." Circulation 143, no. 15 (April 13, 2021): 1468–80. http://dx.doi.org/10.1161/circulationaha.120.052386.
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Background: Bariatric surgery has been shown to significantly reduce cardiovascular risk factors. However, whether surgery can reduce major adverse cardiovascular events (MACE), especially in patients with established cardiovascular disease, remains poorly understood. The present study aims to determine the association between bariatric surgery and MACE among patients with cardiovascular disease and severe obesity. Methods: This was a propensity score–matched cohort study using province-wide multiple-linked administrative databases in Ontario, Canada. Patients with previous ischemic heart disease or heart failure who received bariatric surgery were matched on age, sex, heart failure history, and a propensity score to similar controls from a primary care medical record database in a 1:1 ratio. The primary outcome was the incidence of extended MACE (first occurrence of all-cause mortality, myocardial infarction, coronary revascularization, cerebrovascular events, and heart failure hospitalization). Secondary outcome included 3-component MACE (myocardial infarction, ischemic stroke, and all-cause mortality). Outcomes were evaluated through a combination of matching via propensity score and subsequent multivariable adjustment. Results: A total of 2638 patients (n=1319 in each group) were included, with a median follow-up time of 4.6 years. The primary outcome occurred in 11.5% (151/1319) of the surgery group and 19.6% (259/1319) of the controls (adjusted hazard ratio [HR], 0.58 [95% CI, 0.48–0.71]; P <0.001). The association was notable for those with heart failure (HR, 0.44 [95% CI, 0.31–0.62]; P <0.001; absolute risk difference, 19.3% [95% CI, 12.0%–26.7%]) and in those with ischemic heart disease (HR, 0.60 [95% CI, 0.48–0.74]; P <0.001; absolute risk difference, 7.5% [95% CI, 4.7%–10.5%]). Surgery was also associated with a lower incidence of the secondary outcome (HR, 0.66 [95% CI, 0.52–0.84]; P =0.001) and cardiovascular mortality (HR, 0.35 [95% CI, 0.15–0.80]; P =0.001). Conclusions: Bariatric surgery was associated with a lower incidence of MACE in patients with cardiovascular disease and obesity. These findings require confirmation by a large-scale randomized trial.
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O’Shea, Genevieve. "Ventricular Assist Devices." AACN Advanced Critical Care 23, no. 1 (January 1, 2012): 69–83. http://dx.doi.org/10.4037/nci.0b013e318240aaa9.
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Patients with advanced heart failure have limited treatment options despite advances in medical management. Ventricular assist devices represent a surgical option that offers improved end-organ function, survival, and quality of life. Postoperative nursing management involves the most complicated aspects of care following cardiac surgery as well as issues unique to advanced heart failure and mechanical circulatory support. Despite growing numbers of ventricular assist device implants, literature about the challenging care of patients following ventricular assist device implantation is limited. This article focuses on the physiological basis for postoperative nursing management strategies and the most important complications of which critical care nurses need to be aware.
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Berenstein, Alex, Johanna T. Fifi, Yasunari Niimi, Salvatore Presti, Rafael Ortiz, Saadi Ghatan, Barak Rosenn, Michelle Sorscher, and Walter Molofsky. "Vein of Galen Malformations in Neonates." Neurosurgery 70, no. 5 (November 14, 2011): 1207–14. http://dx.doi.org/10.1227/neu.0b013e3182417be3.
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Abstract BACKGROUND: Untreated patients with symptomatic neonatal presentation of vein of Galen aneurismal malformations (VGAMs) carry almost 100% morbidity and mortality. Medical management and endovascular techniques for neonatal treatment have significantly evolved. OBJECTIVE: To evaluate the clinical and angiographic outcomes of modern management of neonates with refractory heart failure from VGAMs. METHODS: From 2005 to 2010, 16 neonatal patients with VGAM presented to our institution. Medical care from the prenatal to perinatal stages was undertaken according to specified institutional guidelines. Nine patients with refractory heart failure required neonatal endovascular intervention. All patients were treated by transarterial deposition of n-butyl cyanoacrylate into fistula sites. Short- and long-term angiographic studies and clinical outcomes were reviewed. RESULTS: Control of heart failure was achieved in 8 patients. One premature baby died shortly after treatment. Long-term angiographic follow-up shows total or near-total angiographic obliteration in all 8 patients. One patient has a mild hemiparesis from treatment. Another has a mild developmental delay. One patient developed a severe seizure disorder and developmental delay. Overall, 66.7% patients have normal neurological development with near-total or total obliteration of the malformation. CONCLUSION: Treatment of refractory heart failure in neonatal VGAM with modern prenatal, neurointensive, neuroanesthetic, and pediatric neuroendovascular care results in significantly improved outcomes with presumed cure and normal neurological development in most.
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Jacobs, Jeffrey P., Christo I. Tchervenkov, Giovanni Stellin, Hiromi Kurosawa, Constantine Mavroudis, Marcelo B. Jatene, Zohair Al-Halees, et al. "History of the World Society for Pediatric and Congenital Heart Surgery: The First Decade." World Journal for Pediatric and Congenital Heart Surgery 9, no. 4 (June 26, 2018): 392–406. http://dx.doi.org/10.1177/2150135118775962.
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The World Society for Pediatric and Congenital Heart Surgery (WSPCHS) is the largest professional organization in the world dedicated to pediatric and congenital heart surgery. The purpose of this article is to document the first decade of the history of WSPCHS from its formation in 2006, to summarize the current status of WSPCHS, and to consider the future of WSPCHS. The WSPCHS was incorporated in Canada on April 7, 2011, with a head office in Montreal, Canada. The vision of the WSPCHS is that every child born anywhere in the world with a congenital heart defect should have access to appropriate medical and surgical care. The mission of the WSPCHS is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient’s economic means, with an emphasis on excellence in teaching, research, and community service.
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Gliklich, Richard E., and Ralph Metson. "The Health Impact of Chronic Sinusitis in Patients Seeking Otolaryngologic Care." Otolaryngology–Head and Neck Surgery 113, no. 1 (July 1995): 104–9. http://dx.doi.org/10.1016/s0194-59989570152-4.
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Although chronic sinusitis is an increasingly common diagnosis in the United States, the health burden of this disorder relative to the general population and to other chronic diseases has not been previously evaluated. One hundred fifty-eight patients with chronic sinusitis and no prior surgery underwent cross-sectional evaluation by use of the Medical Outcome Study Short-form 36-Item Health Survey. These patients were all referred for otolaryngologic care, and more than 80% subsequently underwent sinus surgery. Mean scores were compared from the eight subscales of general health assessment with similarly derived data for the United States general population. Significant differences ( p < 0.05) were seen in several domains, including bodily pain, general health, vitality, and social functioning. Comparisons with other chronic diseases revealed significantly lower scores ( p < 0.05) in measures of bodily pain and social functioning for sinusitis patients than in patients with congestive heart failure, angina, chronic obstructive pulmonary disease, and back pain. These findings suggest that the national health impact of chronic sinusitis is far greater than is currently appreciated.
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Majchrowicz, Bożena. "Patient care after heart transplantation - a case study." Journal of Education, Health and Sport 13, no. 2 (December 7, 2022): 11–18. http://dx.doi.org/10.12775/jehs.2023.13.02.001.
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Heart transplantation is a recognized and effective method of treating end-stage heart failure. Complicated heart transplant surgery carries a high surgical risk as well as complications that are dangerous to life and health. Transplantation is a life-saving opportunity for patients who have run out of alternative treatments. Patients with heart transplants face many physical and psychological problems every day.
The aim of the work was to discuss the care problems of a patient 3.5 years after the heart transplantation procedure.
Material and methods: The study used a research method - an individual case study, in which the interview technique, observation, analysis of medical documentation and measurement of vital parameters were used.
Results: After the interview, observation and analysis of medical records and as a result of the measurements made, the patient was diagnosed with nursing problems, including such as: increased susceptibility to infections that may pose a serious threat to the life and health of the patient caused by the weakening of the immune system by immunosuppression, anxiety and fear related to the risk of rejection of a transplanted organ and mood instability resulting from uncertain health situation and the effects of immunosuppressive drugs, physical limitations related to with previous operations.
Conclusions: Despite the passage of time, the patient after heart transplantation still feels the fear of a sudden deterioration of his health, the occurrence of side effects of the implemented treatment, and to the greatest extent his organism rejects the transplanted organ. Educating the patient, caring for it and keeping track of his health condition makes him feel more confident and at ease. The quality of life of the patient after transplantation can be significantly improved thanks to discipline and properly conducted self-care and self-care.
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Savage, LS, and MJ Grap. "Telephone monitoring after early discharge for cardiac surgery patients." American Journal of Critical Care 8, no. 3 (May 1, 1999): 154–59. http://dx.doi.org/10.4037/ajcc1999.8.3.154.
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BACKGROUND: Monitoring the postoperative course of cardiac surgery patients remains essential but requires creative strategies now that length of hospitalization has been shortened to 5 days or less. OBJECTIVES: To determine patients' concerns in the early recovery period after open-heart surgery and to describe the impact of advanced practice nurses on this phase of recovery. METHOD: A cardiovascular clinical nurse specialist conducted follow-up by telephone for 342 cardiac surgery patients 7 to 14 days after discharge. Patients were asked both open-ended and direct questions. RESULTS: The major problems were leg edema (48%), appetite disturbance (35%), dyspnea (29%), sleep disturbance (12%), and wound drainage (9%). The nurse's interventions over the telephone included reassuring the patient about postoperative progress (86% of sample), giving diet information (31%), instructing about activity (29%), providing emotional support (25%), referring for medical treatment (16%), and explaining medications (13%). In response to these findings, the nursing practice council revised postoperative teaching to emphasize wound healing, sleep, and appetite issues. CONCLUSIONS: Telephone monitoring of cardiac surgery patients after early discharge can alleviate the often stressful transition to postoperative recovery at home. A cardiovascular clinical nurse specialist can provide patients and patients' family members with reassurance and ongoing reinforcement of the discharge information.
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Chen, Zaomei, and Jingya Wen. "Diagnostic Imaging Analysis and Care of Patients with Endomyocardial Fibrosis Based on Wireless Network Smart Medical Application." Journal of Healthcare Engineering 2022 (March 23, 2022): 1–11. http://dx.doi.org/10.1155/2022/2808889.
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The heart is one of the most important organs of the human body, but in recent years heart disease has become one of the human health killers and this paper explores endomyocardial fibrosis, which is a common cardiomyopathy, commonly seen in infants and children, and refers to a diffuse elastic fibrous disease of the endocardium. The purpose of this paper is to explore the diagnostic imaging analysis and care of patients with endocardial heart machine fibrosis using wireless network intelligent medical technology, aiming to provide a new power basis for the treatment of the disease in related patients. This paper proposes a new endocardial segmentation algorithm that aims to process image information using image features, intervene in image noise reduction and smoothing, etc., and use image grayscale values to confirm cardiac cavity grayscale values as a basis for physicians to make certain judgments for the diagnosis of patients with endocardial machine fibrosis. The experimental results show that the atrial fibrillation group is distinctly higher compared to the sinus rhythm group, with values remaining between 25 and 39, which is a significant advantage compared to other methods.
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Hasserius, Johan, Josefine Hedbys, Christina Graneli, Kristine Hagelsteen, and Pernilla Stenström. "Treatment and Patient Reported Outcome in Children with Hirschsprung Disease and Concomitant Congenital Heart Disease." BioMed Research International 2017 (2017): 1–8. http://dx.doi.org/10.1155/2017/1703483.
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Purpose. Congenital heart disease (CHD) is reported to be associated with Hirschsprung disease (HD). The aim was to evaluate any differences between children with HD with and without CHD, respectively, with regard to patient characteristics, medical care, and patient reported bowel function. Method. This is a retrospective chart study and a cross-sectional long-term follow-up of patients older than 4 years old, including all children with HD operated on with transanal endorectal pull-through (TERPT) at a tertiary center of pediatric surgery. Information about patient characteristics, diagnostics, surgery, and medical care was compiled. At long-term follow-up, bowel function was assessed by Bowel Function Score. Results. Included were 53 HD-patients, 13 with CHD and 40 without CHD. Children with CHD more commonly presented with failure to thrive; 4 (23%) compared to those without CHD (0%) (p<0.01). In the long-term follow-up, including 32 patients (6 with CHD), constipation was more commonly reported by children with CHD 5 (83%) than by children without CHD 4 (27%) (p=0.01). No differences were shown in the other parameters such as fecal control and incontinence. Conclusion. HD-patients with CHD more commonly presented with failure to thrive and more frequently reported constipation than HD-patients without CHD. The findings indicate that HD-patients with CHD might need special consideration in their initial care and long-term follow-up.
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Okunev, I. M., A. M. Kochergina, and V. V. Kashtalap. "Chronic and acute decompensated heart failure: topical issues." Complex Issues of Cardiovascular Diseases 11, no. 2 (June 26, 2022): 184–95. http://dx.doi.org/10.17802/2306-1278-2022-11-2-184-195.
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Highlights. The article is a review of current literary data on the problem of acute decompensated heart failure. The review highlights the basic principles of the diagnosis and treatment, as well as the problems of their implementation into clinical practice.Abstract Acute decompensated heart failure (ADHF) is a life-threatening condition that requires an emergency hospitalization for intensive treatment. Moreover, it is the event that worsens the patient's further prognosis. Frequent rehospitalizations for decompensation of heart failure reduce life expectancy and quality, and are also a significant economic problem in practical health care. The increasing number of patients with heart failure leads to the growing number of patients seeking medical help for acute decompensated heart failure. More than half of the patients are re-hospitalized within a year for the same reason. The predicted increase in the prevalence of CHF worldwide makes the management of such patients a global medical and social problem. Patients delay, low compliance and insufficient ambulatory monitoring are the factors that need to be influenced in order to improve the prognosis. The article is a review of literary data on the epidemiology of ADHF, diagnosis, treatment and outpatient observation of patients with acute decompensated heart failure. The problems of compliance, the prospects for modern methods of remote monitoring and the possibilities of new drugs are discussed in the article.
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King, KB, PC Clark, LH Norsen, and Hicks GLJr. "Coronary artery bypass graft surgery in older women and men." American Journal of Critical Care 1, no. 2 (September 1, 1992): 28–35. http://dx.doi.org/10.4037/ajcc1992.1.2.28.
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OBJECTIVE: To compare women and men younger than 70 years of age and 70 years or older undergoing coronary artery bypass surgery. DESIGN: Retrospective chart review, case-control series. SETTING: University medical center. PATIENTS: All women (n = 465) having first-time isolated coronary artery bypass surgery between 1983 and 1988, and 465 men matched for age and year of surgery. Predominantly white; 33% were 70 years or older. MEASURES: Medical record data: demographics, preoperative comorbidities, perioperative and postoperative complications, mortality, length of stay. RESULTS: Preoperatively, women 70 years of age or older had a higher incidence of congestive heart failure, renal disease and hypertension, and a lower incidence of smoking history compared with women less than 70 years old. Men 70 years or older had a higher incidence of congestive heart failure and renal disease, and a lower incidence of smoking history compared with men less than 70 years old. There was no difference in mortality between older and younger women, whereas the mortality rate for older men was higher than that for younger men. There were fewer differences between women younger than 70 and those 70 years or older in incidence of postoperative complications than between men of those same age groups. Among patients 70 years or older, incidence of postoperative congestive heart failure was greater in women than in men. There were no other differences between women and men younger than 70 and those 70 years or older in incidence of postoperative complications. Controlling for the influence of postoperative complications, age was related to length of stay for women and men. CONCLUSIONS: Older women were at no greater risk of mortality or the occurrence of postoperative complications compared with younger women or older men. A functional component influencing recovery and length of hospital stay needs to be considered to provide optimal nursing care after surgery.
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Sergevnin, Victor I., and Larisa G. Kudryavtseva. "Comparative assessment of the frequency and risk factors of purulent-septic infections in adult patients after various types of open and closed heart surgery." Epidemiology and Infectious Diseases 25, no. 2 (November 23, 2020): 78–87. http://dx.doi.org/10.17816/eid34993.
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BACKGROUND: The widespread increase in the number and types of cardiac surgery necessitate the study of frequency and risk factors of postoperative purulent-septic infections (PSIs).
AIM: to provide a comparative assessment of the PSI frequency and risk factors in adult patients after various types of cardiac surgery.
MATERIALS AND METHODS: Based on the cardiac surgery hospital materials, medical records of 4.815 patients over 18 years of age, who underwent open (n = 1.540) and closed (n = 3.275) heart surgeries within 1 year, were analyzed. The typical and prenosological forms of PSIs were taken into account in accordance with the epidemiological standard of case definition.
RESULTS: The incidence rates for typical and prenosological PSI forms amounted to 39.6 and 72.7 per 1000 surgeries after open heart surgery, respectively, and 3.1 and 3.9 after minimally invasive endovascular surgical interventions, respectively. The main clinical forms of PSI after open and closed heart surgeries were surgical site infections, nosocomial pneumonia, urinary tract infection, and bloodstream infection. In an open heart surgery, the maximum incidence rates for typical and prenosological forms of PSIs were recorded after surgeries on the aorta and less often after heart valve replacement or coronary artery bypass grafting. The increased incidence rate after aortic surgery was mainly due to urinary tract infection and nosocomial pneumonia. In the case of closed heart surgery, no statistically significant differences were detected between the incidence rates of PSIs after coronary artery stenting, cardiac arrhythmia and carotid artery stenosis surgery, and other interventions. The duration of both the surgery itself and the subsequent patient stay in the intensive care unit was found to be important as risk factors for PSIs after cardiac surgery.
CONCLUSION: The incidence rate of PSIs after open heart surgery is significantly higher than after closed heart surgery, which is mostly associated with the duration of surgical intervention and the subsequent patient stay in the intensive care unit.
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Puri, Archana, Raj Tobin, Shameek Bhattacharjee, and Mukul Chandra Kapoor. "Noncardiac surgery in patients with a left ventricular assist device." Asian Cardiovascular and Thoracic Annals 28, no. 1 (December 10, 2019): 15–21. http://dx.doi.org/10.1177/0218492319895840.
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Left ventricular assist devices are implanted in patients with chronic left heart failure refractory to maximal medical therapy. These devices were initially meant as bridge-to-transplant therapy, but with technological advances they are now also used as destination therapy. With improved survival, many patients with implanted devices need noncardiac surgery. We present three representative cases of noncardiac surgery in such patients to highlight the issues involved in their management. We also review the contemporary literature on various aspects of perioperative management. Anesthesia for noncardiac surgery in these patients was initially the domain of cardiac anesthesiologists, but with an increasing number of such patients needing surgery, general anesthesiologists are frequently tasked to provide anesthetic care. An understanding of left ventricular assist device physiology and issues unique to these patients is essential for safe management of these cases.
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Salehi, Seyed Hamid, Kamran As’adi, and Ali Abbaszadeh-Kasbi. "The prevalence of comorbidities among acute burn patients." Trauma 21, no. 2 (May 10, 2018): 134–40. http://dx.doi.org/10.1177/1460408618773514.
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Introduction The elderly population in Iran is growing, and more medical comorbidities can be identified, so hospital admissions of burn patients with associated medical comorbidities are expected to rise as well. As these medical comorbidities may affect the prognosis of burn patients, additional health care services are likely to be required. Therefore, the aim of this study was to determine the prevalence of comorbidities among patients with burn injury. Methods A retrospective study of all burn patients admitted to the Motahari Burn Hospital, Iran over a 14-month period was conducted. Variables gathered from patients’ medical record files were demographic characteristics, clinical burn features, hospital course, and preexisting comorbidities. The comorbidity score of patients was calculated by using the updated Charlson comorbidity index. Results A total of 732 patients were hospitalized, 136 (18.5%) patients had comorbidities, and more than 57% of elderly people (≥61 years) had one or more comorbid conditions. The most common cause of burn injury among the comorbid patients was scald (38.2%) injury. The two most frequent comorbid conditions among all cases were congestive heart failure (25.8%) and diabetes (23.5%), respectively. As patients got older, the Charlson score also increased. There were no significant differences between comorbid and noncomorbid patients in terms of hospitalization period and mortality rate. Those comorbid patients who died had significantly higher Charlson score and larger mean burn sizes compared to surviving comorbid patients; they were also significantly older. Conclusion The prevalence of comorbidities in burn patients was 18.5% and among older burn patients rose to 57%. Diabetes and congestive heart failure were the two most common comorbid conditions.
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Davisson, Neena A., Joseph B. Clark, Thomas K. Chin, and Robert D. Tunks. "Trisomy 18 and Congenital Heart Disease: Single-Center Review of Outcomes and Parental Perspectives." World Journal for Pediatric and Congenital Heart Surgery 9, no. 5 (August 29, 2018): 550–56. http://dx.doi.org/10.1177/2150135118782145.
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Background: In patients with trisomy 18, congenital heart surgery is controversial due to anticipated poor patient outcome. Data are lacking regarding clinical outcomes and family opinions about care received. Methods: A retrospective chart review of patients with trisomy 18 and congenital heart disease from 2005 to 2017 was performed. Patients were grouped into those receiving cardiac intervention (surgery or cardiac catheterization) versus medical management. A telephone survey was used to assess completeness of family counseling provided prior to treatment selection and parental opinions on the care received. Results: Seventeen infants were assessed. In the medical management group (n = 7), there were five deaths at a median age of 1.5 months (range: 1.2-4.1 months) and two survivors aged 29 and 44 months at latest follow-up. In the intervention group (n = 10), cardiac surgery was performed in nine patients at a median age of 4.3 months (0.2-23.4 months) and weight of 3.2 kg (1.5-12.2 kg); catheter intervention was performed in one patient at one week of age. At latest follow-up, seven intervention patients are alive at a median age of 50 months (5-91 months). Survey respondents (n = 12) unanimously stated that their child’s quality of life was improved by their specific treatment strategy, that the experience of the parents was enhanced, and that they would choose the same treatment course again. Conclusions: Surgical repair may be associated with favorable early outcomes and may be judiciously offered in selected circumstances. In this limited experience, parental perceptions were positive regarding the quality of care and overall experience independent of the chosen treatment strategy or eventual outcome.
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Belanger, Michael, Luke Tan, and Carin Wittnich. "Does young age really put the heart at risk?" Canadian Journal of Physiology and Pharmacology 95, no. 10 (October 2017): 1177–82. http://dx.doi.org/10.1139/cjpp-2017-0072.
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Despite significant advances in the management and treatment of heart disease in children, there continue to be patients who have worse outcomes than might be expected. A number of risk factors that could be responsible have been identified. Evidence-based findings will be reviewed, including whether young age and (or) reduced body weight exacerbate these responses. For example, newborn children undergoing congenital cardiac surgery are known to have worse outcomes than older children. Evidence exists that newborn hearts do not tolerate ischemia as well as adult hearts, developing irreversible injury sooner and exhibiting at-risk metabolic profiles. As well, in response to the administration of heparin, elevations in free fatty acids occur during congenital heart surgery in children, which can have detrimental effects on the heart. Furthermore, myocardial energetic state has also been suggested to impact outcomes. Unfavourable energetic profiles were correlated to lower body weights in the same age healthy newborn piglet model. Newborn children suffering from congenital heart disease, with lower body weights, also had lower myocardial energetic state and this correlated with longer postoperative ventilatory support as well as a trend to longer intensive care unit stay. These findings imply that unfavourable myocardial metabolic profiles could contribute to postoperative complications.
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Kudryavtseva, L. G., P. V. Lazarkov, and V. I. Sergevnin. "Comparative assessment of risk of development of purulent septic infections in children after open and closed cardiac operations for congenital diseases." Medical alphabet, no. 32 (December 17, 2021): 41–44. http://dx.doi.org/10.33667/2078-5631-2021-32-41-44.
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Purpose of the study. Comparative assessment of the incidence of nosocomial purulent-septic infections (PSI) in children after open and closed heart surgery for congenital defects.Materials and methods. 503 medical records of children after cardiac surgery were studied. GSI was identified according to epidemiological standard case definitions.Results. It turned out that the incidence rate of PSI in children after open heart surgery is an order of magnitude higher than after minimally invasive endovascular interventions. Hospital-acquired pneumonia most often occurs in children after operations.Conclusion. The increased incidence of PSI after open heart surgery, as compared to endovascular surgery, is due to a longer surgical intervention and the subsequent longer stay of patients in the intensive care unit, where such an epidemiologically significant procedure as artificial lung ventilation is performed.
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Karlsson, Ann-Kristin, Evy Lidell, and Mats Johansson. "Health-care professionals' documentation of wellbeing in patients following open heart surgery: a content analysis of medical records." Journal of Nursing Management 21, no. 1 (October 8, 2012): 112–20. http://dx.doi.org/10.1111/j.1365-2834.2012.01458.x.
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Steeds, Richard P., Vandana Sagar, Shishir Shetty, Tessa Oelofse, Harjot Singh, Raheel Ahmad, Elizabeth Bradley, et al. "Multidisciplinary team management of carcinoid heart disease." Endocrine Connections 8, no. 12 (December 2019): R184—R199. http://dx.doi.org/10.1530/ec-19-0413.
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Carcinoid heart disease (CHD) is a consequence of valvular fibrosis triggered by vasoactive substances released from neuroendocrine tumours, classically in those with metastatic disease and resulting in tricuspid and pulmonary valve failure. CHD affects one in five patients who have carcinoid syndrome (CS). Valve leaflets become thickened, retracted and immobile, resulting most often in regurgitation that causes right ventricular dilatation and ultimately, right heart failure. The development of CHD heralds a significantly worse prognosis than those patients with CS who do not develop valvular disease. Diagnosis requires a low threshold of suspicion in all patients with CS, since symptoms occur late in the disease process and clinical signs are difficult to elicit. As a result, routine screening is recommended using the biomarker, N-terminal pro-natriuretic peptide, and regular echocardiography is then required for diagnosis and follow-up. There is no direct medical therapy for CHD, but the focus of non-surgical care is to control CS symptoms, reduce tumour load and decrease hormone levels. Valve surgery improves long-term outcome for those with severe disease compared to medical management, although peri-operative mortality remains at between 10 and 20% in experienced centres. Therefore, care needs to be multidisciplinary at all stages, with clear discussion with the patient and between teams to ensure optimum outcome for these often-complex patients.
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Memeti, Shaban, Saimir Kuci, Alfred Ibrahimi, Marsela Goga, Altin Veshti, Sokol Buba, and Arben Baboci. "Perioperative Management of a Child with Hypoplastic Left Heart Syndrome Undergoing Cryptorchidism Surgery." Open Access Macedonian Journal of Medical Sciences 10, no. C (September 24, 2022): 272–75. http://dx.doi.org/10.3889/oamjms.2022.9869.
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Hypoplastic left heart syndrome (HLHS) is a complex congenital heart condition which includes abnormal development of left sided cardiac structures leading to inadequate systemic perfusion following postnatal closure of the patent ductus arteriosus (PDA).
Surgical palliation may be accomplished through a 3 staged process
-Norwood procedure. This surgery is usually done within the first two weeks of your child's life
-Bidirectional Glenn procedure. This procedure is generally the second surgery. It's done when your child is between 3 and 6 months of age.
-Fontan procedure. This surgery is usually done when your child is between 18 months and 4 years of age.
Patients with HLHS may need to undergo other non-cardiac surgical procedures during the first years of life posing a real challenge to the anesthesiologist, surgeon and the entire medical team.
We present the case of a 18-months old, 9 kg infant who presented for cryptorchidism surgery. Cryptorchidism or undescended testis (UDT) is one of the most common pediatric disorders of the male endocrine glands and the most common genital disorder identified at birth. The main reasons for treatment of cryptorchidism include increased risks of impairment of fertility potential, testicular malignancy, torsion and/or associated inguinal hernia.
The intraoperative implications of the hybrid anatomy are discussed, options for anesthetic care presented, and previous reports of anesthetic care for such patients reviewed.
Conclusion: LMA combined with local anesthesia was effective to maintaining optimal cardiac function of this child patient with HLHS
In summary, children with palliated HLHS have anesthetic considerations that must be followed in order to reduce perioperative morbidity and mortality in this high-risk pathology.
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Ivarsson, Bodil, Trygve Sjöberg, and Sylvia Larsson. "Waiting for Cardiac Surgery—Support Experienced by Next of Kin." European Journal of Cardiovascular Nursing 4, no. 2 (June 2005): 145–52. http://dx.doi.org/10.1016/j.ejcnurse.2004.11.002.
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Background: Next of kin (NoK) play a crucial role for patients waiting for cardiac surgery. Aim: To describe experience of support, in the form of important events, by next of kin while their intimates were waiting for a heart operation. Methods: The design was qualitative and the “critical incident” technique was used. Incidents were collected via interviews with 23 next of kin to patients waiting for heart surgery and the informants were chosen by the patient themselves. Findings: In all, 224 important events, both positive and negative, were identified in the interviews and two main areas emerged in the analysis: internal factors and external factors. Positive internal factors were associated with finding strength, whereas negative factors were associated with uncomfortable feelings. Positive external factors were associated with participating in care and receiving attention, whereas negative factors were associated with dissatisfaction with the health-care organization and failing social network. Conclusion: This study shows that next of kin experienced positive support when they received attention and information and felt involvement in the care. An important implication for the health-care professionals and public authorities is the understanding of the experience of support expressed by next of kin, to provide them with optimal information and support.
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Mangusan, Ralph Francis, Vallire Hooper, Sheri A. Denslow, and Lucille Travis. "Outcomes Associated With Postoperative Delirium After Cardiac Surgery." American Journal of Critical Care 24, no. 2 (March 1, 2015): 156–63. http://dx.doi.org/10.4037/ajcc2015137.
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Background Delirium after surgery is a common condition that leads to poor outcomes. Few studies have examined the effect of postoperative delirium on outcomes after cardiac surgery. Objectives To assess the relationship between delirium after cardiac surgery and the following outcomes: length of stay after surgery, prevalence of falls, discharge to a nursing facility, discharge to home with home health services, and use of inpatient physical therapy. Methods Electronic medical records of 656 cardiac surgery patients were reviewed retrospectively. Results Postoperative delirium occurred in 161 patients (24.5%). Patients with postoperative delirium had significantly longer stays (P < .001) and greater prevalence of falls (P < .001) than did patients without delirium. Patients with delirium also had a significantly greater likelihood for discharge to a nursing facility (P < .001) and need for home health services if discharged to home (P < .001) and a significantly higher need for inpatient physical therapy (P < .001). Compared with patients without postoperative delirium, patients who had this complication were more likely to have received zolpidem and benzodiazepines postoperatively and to have a history of arrhythmias, renal disease, and congestive heart failure. Conclusions Patients who have delirium after cardiac surgery have poorer outcomes than do similar patients without this complication. Development and implementation of an extensive care plan to address postoperative delirium is necessary for cardiac surgery patients who are at risk for or have delirium after the surgery.
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Valera, Mariangela, Carlo Scolfaro, Nazario Cappello, Elena Gramaglia, Sergio Grassitelli, Maria Teresa Abbate, Alberta Rizzo, et al. "Nosocomial Infections in Pediatric Cardiac Surgery, Italy." Infection Control & Hospital Epidemiology 22, no. 12 (December 2001): 771–75. http://dx.doi.org/10.1086/501861.
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AbstractObjective:To evaluate the incidence of nosocomial infection (NI) in pediatric patients who received cardiothoracic surgery and to identify possible associated risk factors.Design:Prospective observational study.Setting:The cardiac surgery and cardiac intensive care units at the Regina Margherita Children's Hospital, Turin, Italy.Patients:All patients who underwent surgery from July 20,1998, to July 19,1999, were enrolled, except patients with operative catheterization only.Methods:Clinical data were collected daily from July 20, 1998, to July 19, 1999. NIs were diagnosed according to US Centers for Disease Control and Prevention criteria.Results:104 patients were included in the present study, 80 (76.9%) of whom underwent extracorporeal circulation. The NI ratio was 48.1% (50/104); the percentage of patients with NI was 30.8% (32/104): 23.1% developed one infection, 7.7% two or more. The rate of NI was 2.17 per 100 days of hospitalization (50/2,304). The most common pathogen wasPseudomonas aeruginosa,Important risk factors were length of preoperative admission >5 days, total length of admission >10 days, open chest during postoperative phase, and cyanotic heart disease. There was a significant association between sepsis and central venous catheterization for 3 days or more. Rate of sepsis was 19 per 1,000 catheter days (16/852).Conclusion:NIs represent a frequent complication for children who undergo heart surgery. Based on our data, we suggest decreasing the preoperative stay as much as possible. The higher NI incidence in patients with an open chest postoperatively suggests that an alternative antibiotic strategy should be considered for these patients.
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Dearani, Joseph A., Heidi M. Connolly, Richard Martinez, Hector Fontanet, and Gary D. Webb. "Caring for adults with congenital cardiac disease: successes and challenges for 2007 and beyond." Cardiology in the Young 17, S4 (September 2007): 87–96. http://dx.doi.org/10.1017/s1047951107001199.
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AbstractPatients with congenital cardiac disease require lifelong medical care. Current challenges that face practitioners who care for adults with congenital heart disease include identifying the best location for procedures, which could be a children’s hospital, an adult hospital, or a tertiary care facility; providing appropriate antenatal management of pregnant women with congenitally malformed hearts, and continuing this care in the peripartum period; and securing the infrastructure and expertise of the non-cardiac subspecialties, such as nephrology, hepatology, pulmonary medicine, and haematology. The objectives of this review are to outline the common problems that confront this population of patients and the medical community, to identify challenges encountered in establishing a programme for care of adults with congenitally malformed hearts, and to review the spectrum of disease and operations that have been identified in a high volume tertiary care centre for adult patients with congenital cardiac disease. Three chosen examples of the fundamental problems facing the practitioner and patient in the United States of America in 2007 are the neglected patient with congenital cardiac disease, weak infrastructure for adults with congenital cardiac disease, and family planning and management of pregnancy for patients with congenital cardiac disease.Patients with adult congenital cardiac disease often do not receive appropriate surveillance. Three fundamental reasons for this problem are, first, that most adults with congenitally malformed hearts have been lost to follow-up by specialists, and are either receiving community care or no care at all. Second, patients and their families have not been educated about their malformed hearts, what to expect, and how to protect their interests most effectively. Third, adult physicians have not been educated about the complexity of the adult with a congenitally malformed heart. This combination can be fatal for adults with complications related to their congenitally malformed heart, or its prior treatment. Two solutions would improve surveillance and care for the next generation of patients coming out of the care of paediatric cardiologists. The first would be to educate patients and their families during childhood and adolescence. They would learn the names of the diagnoses and treatments, the problems they need to anticipate and avoid, the importance of expert surveillance, career and family planning information, and appropriate self-management. The second solution would be to encourage an orderly transfer of patients from paediatric to adult practice, usually at about 18 years of age, and at the time of graduation from high school.Clinics for adults with congenital cardiac disease depend upon multidisciplinary collaboration with specialties in areas such as congenital cardiac imaging, diagnostic and interventional catheterization, congenital cardiac surgery and anaesthesia, heart failure, transplantation, electrophysiology, reproductive and high risk pregnancy services, genetics, pulmonary hypertension, hepatology, nephrology, haematology, and others. None of these services are easily available “off the rack”, although with time, experience, and determination, these services can develop very well. Facilities with experienced personnel to provide competent care for adults with congenital cardiac disease are becoming increasingly available. Parents and patients should learn that these facilities exist, and be directed to one by their paediatric caregivers when the time comes for transition to adult care.With the steady increase in the number of adults with congenital heart disease, an ever increasing number of women with such disease are becoming pregnant. Services are not widely available to assess competently and plan a pregnancy for those with more complex disease. It is essential to have a close interplay between the obstetrician, the adult congenital cardiologist, the fetal medicine perinatologist, and neonatologist.In both a community based programme and a tertiary care centre, the nuances and complexities of congenital cardiac anatomy, coupled with the high probability of previous operation during childhood, makes the trained congenital cardiothoracic surgeon best suited to deal with the surgical needs of this growing population. It is clear that the majority of adults with congenital heart disease are not “cured”, but require lifelong comprehensive care from specialists who have expertise in this complex arena. There is a growing cadre of healthcare professionals dedicated to improving the care of these patients. More information has become available about their care, and will be improved upon in the next decade. With the support of the general paediatric and paediatric cardiologic communities, and of the Adult Congenital Heart Association, and with the persistence of the providers of care for adults with congenital cardiac disease currently staffing clinics, the care of these patients should become more secure in the next decade as we mature our capabilities.