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The Adult With Congenital Heart Disease

Born To Be Bad?

Division of Cardiovascular Diseases and Pediatric Cardiology, Mayo Clinic College of Medicine, Rochester, Minnesota

View larger version (19K): [in a new window]   Figure 1 Long-term outcome of patients surviving the perioperative period according to age at operative closure of their atrial septal defect. Expected survival in an age- and gender-matched control population is also shown. When patients undergo repair 25 years of age, survival is significantly reduced compared with control subjects. Reprinted, with permission, from Murphy et al. (2).

View larger version (120K): [in a new window]   Figure 2 Aortogram from a 40-year-old man with mild coarctation (gradient 18 mm Hg). The entire aorta is dilated (ascending aorta = 40 mm), and the arch vessels are also dilated, indicating a diffuse arterial problem.

View larger version (89K): [in a new window]   Figure 3 (A) Chest radiograph of a 16-year-old young man with congenitally corrected transposition just after implantation of an endocardial pacemaker. Reportedly, his systemic ventricular ejection fraction was 40%, and he had moderate systemic atrioventricular valve (the tricuspid valve) regurgitation. (B) Chest radiograph 18 months later at the time of referral. His systemic ventricular ejection fraction was 15%, and he had severe systemic atrioventricular valve regurgitation. Cardiac transplantation was the only viable surgical option, because the referral was too late for conventional operation.

View larger version (17K): [in a new window]   Figure 4 Age of the patient population seen at the Adult Congenital Heart Disease Clinic at Mayo Clinic shown by decade. Of more than 3,000 patients, 38% are over 40 years of age. Pt = patient.

View larger version (17K): [in a new window]   Figure 5 Cardiac operations performed at the Adult Congenital Heart Disease Clinic at Mayo Clinic from 1987 to 2003 (n = 1,284). More than one-third of the patients had operation number 3 or higher. no. = number of patients.