When Hearts Grow Up

Congenital heart disease (CHD) is the most common form of birth defect, affecting approximately one in 150 births, and it is often diagnosed and treated in childhood. Since the 1970s, open-heart surgery has allowed repair or partial correction of many defects, enabling the majority of CHD patients to survive into adulthood. Many patients and their physicians, however, mistakenly believe that a successful childhood surgery represents a “cure,” so regular cardiology care in adulthood has not been the norm. In fact, less than half of adult CHD patients are thought to receive such care after they “outgrow” their pediatric cardiologist.

Adult Congenital Heart Disease Program team members (from left): Reina Covarrubias, R.N.; Angela Chriss, R.N.; Nicole Benjamin, P.A.-C.; Michael Luna, M.D.; Beth Brickner, M.D.; and Lisa Forbess, M.D.

For Congenital Heart Disease patients with more complex defects, care is often provided by pediatric cardiologists — even well into the patient’s adult years — because many adult cardiologists have not been trained in the treatment of these patients. A UT Southwestern team — members of the UTSW Adult Congenital Heart Disease Program — is a notable exception to this situation, offering a high degree of expertise to meet adult CHD patients’ cardiac and general medical needs.

“For most patients, surgery for CHD does not result in a cure, and patients remain at risk for a variety of complications in adulthood, ranging from arrhythmias to heart failure and even sudden death,” says Beth Brickner, M.D., Co-Director of the program. “Some of these problems are preventable with regular follow-up and surveillance. When caught early, serious heart issues such as arrhythmias, ventricular dysfunction, valvular dysfunction, pulmonary hypertension, and deterioration of prosthetic materials can be addressed before irreversible damage is done.”

Pregnancy for CHD patients can be challenging as well and needs subspecialty care, she notes. Non-cardiac surgery can be complicated for patients with moderate or complex defects and requires careful perioperative management and anesthesia.

Expert Care for More Than a Decade

In September 2013, the American Board of Medical Specialties officially recognized Adult Congenital Heart Disease as a specific subspecialty of cardiology, requiring specific training and certification.

The first certifying exam will be offered in 2015. By working in close collaboration with the Pediatric Cardiology and Pediatric Cardiothoracic Surgery Program at Children’s Medical Center, the UT Southwestern Adult Congenital Heart Disease Program has already been providing expert comprehensive care for adult patients with CHD for more than 10 years, according to Dr. Brickner. “Some patients are transitioned from their pediatric cardiologist at Children’s to the adult program, but many patients are referred by outside physicians to help diagnose and manage their congenital heart disease,” she says.

UT Southwestern physicians in the program offer experience in the management of adult CHD patients (both inpatient and outpatient), using advanced imaging (echo, CT, and MRI), diagnostic and interventional catheter procedures, pacemakers, and arrhythmia management. Cardiac surgery is performed by pediatric heart surgeons in collaboration with UTSW adult cardiac surgeons. Patients with moderate or high-risk CHD requiring non-cardiac surgery are cared for in a collaborative fashion with the surgical team and cardiac anesthetist to provide optimal surgical outcomes.

High-risk pregnancies for mothers with CHD are treated in collaboration with UTSW maternal-fetal medicine physicians. “We also work closely with the pulmonary hypertension teams and the heart failure/transplant team to provide the full spectrum of care for these patients,” Dr. Brickner says.

Schedule an Appointment

UT Southwestern Adult Congenital Heart Disease Program team members are available for consultation with referring physicians. To schedule an appointment, call 214-645-8300.