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G rown U p C ongenital H eart (disease)

G rown U p C ongenital H eart (disease). 1965. 1500.000. ↑ 5% anno. 1250.000. 1000.000. 750.000. 500.000. 250.000. 1970. 1980. 1990. 2000. 2010. JACC 2001 Warnes JACC 2006 Williams. 2005. %. RVEF. Millane JACC 2000. Vander Velde Eur J Epidemiol 2005.

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G rown U p C ongenital H eart (disease)

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  1. Grown Up Congenital Heart(disease)

  2. 1965

  3. 1500.000 ↑ 5% anno 1250.000 1000.000 750.000 500.000 250.000 1970 1980 1990 2000 2010 JACC 2001 Warnes JACC 2006 Williams

  4. 2005

  5. % RVEF Millane JACC 2000

  6. Vander Velde Eur J Epidemiol 2005

  7. Beta/Blocker treatment ACE/ARB treatment Losartan … 7 pts Lester AmJ C 2001 … 8 pts Josephson Can J Card 2006 Enalapril ….. 14 pts Hecther AmJC 2001 …..31 pts DoughanAm J Card 2007 Enalapril …. 9 pts Robinson Ped Card 2002 …. 14 pts Bouallal Card Young 2010 Losartan .. 37 pts Dore Circ 2005 Ramipril … 17 pts Therrien InT J Card 08 No high-quality data support the use It is difficult to conclude that B/blockade is beneficial

  8. Cardiac conditions at highest risk Type of procedure at risk

  9. % Engelfriet Eur H J 2005

  10. The principal reasons for 373 medical admissions to the Royal Brompton Hospital GUCH unit in 1997. Sommerville Heart 2002

  11. % Kaemmerer Am JC 2008

  12. The updated recommendations dramatically change long established practice for primary care physicians,cardiologists, dentists, and their patients. For ethical reasons, these practitioners need to discuss the potential benefit and harm of antibiotic prophylaxis with their patients before a final decision is made. Following informed review and discussion, some patients (and also physicians) may wish to continue with routine prophylaxis in the individual case, and these views should be respected.

  13. Br Med Bull. 2008;85:151-80. Adult congenital heart disease: a 2008 overview. Bédard E, Shore DF, Gatzoulis MA. Source Adult Congenital Heart Center and Center for Pulmonary Arterial Hypertension, Royal Brompton Hospital, Sydney Street, London SW3 6NP, UK Current ACC/AHA GL are much more restrictive concernig the use of prophylactic antibiotics. However , we advocate a prudent approach for endocarditis prohylaxis in patients with CHD

  14. Good oral hygiene and regular dental review have an essential role in reducing the risk of IE. It appears plausible that a large proportion of IE-causing bacteraemia may derive from daily routine activities such as tooth brushing, flossing…. In the majority of patients, no potential index procedure preceding the first clinical appearance of IE can be identified Transient bacteraemia occurs frequently in the context of these daily routine activities

  15. Atrial septal defect Interventional options: surgery or device closure Unresolved issues: surgery vs device closure

  16. % JACC 2001 Warnes

  17. Y Engelfriet Eur H J 2005

  18. Ebstein’s anomaly RV to PA conduits

  19. VO2 ml/kg/m Normali Normali NYHA I NYHA I NYHA II NYHA II NYHA III NYHA III GUCH età media 33 y Pazienti HF età media 59 y ….all should have a measurement of exercise physiology Diller Circulation 2005

  20. Analyzing the mortality causes in GUCH pts it appears that cardiovascular death is the most frequent: 65% of all deaths, excluding the perioperative cardiac surgery deaths. The most common mode is SD, followed by progressive HF Am J Cardiol 2000 Oechslin

  21. ICD therapy in adult patients with ToFWitte Europace 2008 Specific criteria for ICD implantation for primary prevention have not been well defined yet ICD in Tetralogy of Fallot Khairy Circ 2008 SD and ICD in TGA With Intra-atrial Baffles: A Multicenter Study Khairy Circ Arr 2008 ...inappropriate anti-tachycardia pacing delivery (20%) and inappropriate cardioversion (25 %) ... Conclusion :Tetralogy of Fallot patients have a higher risk of inappropriate therapies ….. 36 patients (29.8%) experienced complications, of which 6 (5.0%) were acute, 25 (20.7%) were late lead-related, and 7 (5.8%) were late generator-related complications. Conclusions:…late lead-related complications are common. 14 patients (37.8%) experienced complications: 5 (13.5%) acute, 1 (2.7%) late generator related, and 12 (32.4%) late lead related.

  22. Cardiologo pediatra Cardiologo dell’adulto GUCH

  23. IGG RETE INTERAZIENDALE per la GESTIONE dei GUCH Ambulatorio per i GUCH ASL 3 - Nervi ICLAS GUCH ASl 3 Cardiologo Pediatra Cardiologo dell’Adulto

  24. IGG RETE INTERAZIENDALE per la GESTIONE dei GUCH Ambulatorio per i GUCH ASL 3 - Nervi ASl 3 ICLAS GUCH Cardiologo Pediatra Cardiologo dell’Adulto

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