Pediatric cardiology is one of the oldest of the pediatric
subspecialties. The last half of the 20th century showed a remarkable change
in the focus of cardiologists from the treatment of acquired cardiac
disease, like rheumatic fever, to the diagnosis and treatment of congenital
heart defects of increasing complexity. Since the 1960s, each decade has
brought new tools and medications to aid pediatric cardiologists in their
care of children with heart disease. Arguably, one of the greatest tools,
2-dimensional and Doppler echocardiography, allows cardiologists to rapidly
and accurately obtain vital anatomic and physiologic information
noninvasively on patients of all ages. This tool was extended to prenatal
diagnosis late in the 20th century. In the 1970s and 1980s, advances in
surgical techniques and equipment that allowed surgery on small infants and
children changed our management strategies for complex congenital heart
disease from palliative to “corrective” therapies. Advances in
cardiac catheterization and the birth of interventional cardiac procedures
have allowed pediatric cardiologists the ability to offer nonsurgical
options to many patients, where none existed before.
These remarkable therapeutic changes have resulted in several shifts of
focus in pediatric cardiology. In clinical care, there is continued effort
in determining the best management strategies for patients, including early
diagnosis and the use of clinical guidelines. Importantly, the number of
survivors with congenital heart disease of all types has grown
exponentially, including patients with very complex disease who never lived
to adulthood before the current era. This mandates that all primary care
practitioners become well-versed in the wide range of diseases that now
exist in the pediatric and young adult population. This book provides
multiple chapters with information to allow primary care providers to become
familiar with the tools used in the care of pediatric cardiology patients
and the opportunity to review the different types of congenital heart
defects in detail. Each chapter describes the cardiac anatomy and
physiology, but also includes the management strategies that we use.
The management focus has also shifted from the postnatal
diagnosis of congenital heart disease to prenatal diagnosis. This book
provides a chapter for primary care physicians to become more familiar with
the information gathered by fetal cardiologists from fetal echocardiography
and how fetal diagnosis has impacted upon the care of patients and families
with serious congenital heart disease. On the opposite end of the spectrum,
the growing population of adults with congenital heart disease is an
emerging and problematic issue. Here we face our greatest unknowns and
challenges. Additionally, as this patient pool expands, it will mandate the
need for more adult cardiac specialists with specific knowledge of
congenital heart disease and the various management strategies that have
allowed their survival. Currently, there are a relatively small number of
adult specialists with this expertise, compared to the number of adult
patients. This will prove to be a vital area of need in the future. This
book provides a chapter that reviews some of these critical adult congenital
heart issues.
In the current era, the likelihood
that an infant with complex congenital heart disease will survive is very
high. An area of growing research is how these children are doing from a
neurocognitive perspective. It is not enough that a child survives heart
surgery and goes to school. What is also important is how the child
functions in the world with his or her peers. This is of critical importance
to the family, and it is very important that primary care providers know
what to be on the alert for, whether it be learning disabilities or other
psychosocial issues that strain the child and family. This unique area is
covered in a chapter that should be of interest to all readers.
Although congenital heart disease is a common form of
birth defect in the general population, it is not the only type of heart
problem approached in this book. The different forms of acquired
inflammatory heart disease are reviewed here. Additionally, there is an
important chapter that addresses the risk factors for acquired adult heart
disease (atherosclerosis, hypertension, and obesity) during childhood. Given
the epidemic of childhood obesity, this is a matter of high concern both to
physicians and families, and this chapter should be of special interest to
all primary care providers.
In the research realm,
there is continued growth and interest in understanding the genetics and
pathophysiology of the various congenital heart defects. This is a vast and
complex area and cannot be reviewed in detail here. We have, however,
included a chapter that reviews the current tools available to assess the
genetics of congenital heart disease, as well as the forms of congenital
heart disease that are associated with certain known syndromes. Perhaps in a
different decade, the results of research efforts will allow us to intervene
and either modify or alleviate some forms of congenital heart disease.
It is important to remember that the care of the pediatric
heart patient is a joint effort between the subspecialist and the primary
care practitioner. When physicians work with a shared knowledge base, then
the care of the patient will be enhanced. It is our hope that this book will
provide valuable information about all aspects of congenital and acquired
heart disease to our colleagues in primary care medicine. It should also be
helpful to medical students and pediatric or family practice residents in
learning more about this important subspecialty. Whether you are a physician
in the office, a nurse practitioner in a clinic, an emergency medicine
physician, a dentist, or an obstetrician-gynecologist, there is no doubt
that patients with congenital and acquired heart disease will cross your
path. Given the variety of types of cardiac disease that exist, this can be
an overwhelming concern. Our goal is that this book be an easy and reliable
resource for obtaining up-to-date and accurate information as rapidly as
possible. In that way, we can hope to ensure excellent care of these complex
patients in the future.
Marie M. Gleason
Jack Rychik
Robert Shaddy