J. Timothy Bricker

Adults with childhood illness

The purpose of this special issue is to provide a practical resource for clinicians who are encountering new groups of patients with diagnoses that were once exclusive to the care of children. For example, there are now more adults with cystic fibrosis than children owing to our successes in pediatric care. This experience is being replicated with many other diseases. This issue targets the needs of primary care providers for adults who have these conditions as well as trainees who are in pediatric, internal medicine, family practice, and med-peds training programs. Adult subspecialists with low familiarity with the pediatric disorders and pediatric subspecialists who are involved in transitioning to adult care are groups will find information published here of interest. Coordination of adult and pediatric care has been facilitated at the University of Kentucky and Kentucky Children’s Hospital by integration of training programs and a tradition of coordinated care for the ‘‘graduates’’ of our pediatric specialty programs. Most of the authors have board certification in both adult and pediatric care. All have extensive experience with the care of patients with the pediatric diagnoses as well as transition into adult years. We believe that confidence, comfort and information will be acquired from this issue to improve the care of grownups with childhood disease diagnoses and to support health professionals working in the transition from pediatric to adult care.

Cyanotic congenital heart defects in adult patients

Abstract Usually cyanotic heart defects are fatal in infancy and childhood without surgical treatment. There are rare circumstances in which a cyanotic individual can survive into adult years with reasonably good health. Prolonged survival in unop-erated cyanotic heart defect cases is dependent upon well-balanced circulation with pulmonary blood flow that is near normal but not excessive. Physicians in practice can encounter such cases in which diagnosis was missed in childhood or who had a diagnosis of a cardiac malformation but are recent immigrants from a part of the world in which surgical treatment was not possible. These unusual survivors have a different spectrum of anatomic malformations than the cyanotic defects found in newborn babies. Even with a well-balanced circulation, chronic ventricular volume overload is likely to lead to myocardial dysfunction over time. The evaluation by a cardiac team with expertise in the treatment of congenital cardiac defects in adult patients is important to long-term health and survival of the patients.