Jennifer F. Gerardin

Improving the quality of transition and transfer of care in young adults with congenital heart disease: Everitt et al.

The transition and transfer from pediatric to adult care is becoming increasingly important as improvements in the diagnosis and management of congenital heart disease allow patients to live longer. Transition is a complex and continuous process that requires careful planning. Inadequate transition has adverse effects on patients, their families and healthcare delivery systems. Currently, significant gaps exist in patient care as adolescents transfer to adult care and there are little data to drive the informed management of transition and transfer of care in adolescent congenital heart disease patients. Appropriate congenital heart disease care has been shown to decrease mortality in the adult population. This paper reviews the transition and transfer of care processes and outlines current congenital heart disease specific guidelines in the United States and compares these recommendations to Canadian and European guidelines. It then reviews perceived and real barriers to successful transition and identifies predictors of success during transfer to adult congenital heart disease care. Lastly, it explores how disease-specific markers of outcomes and quality indicators are being utilized to guide transition and transfer of care in other chronic childhood illnesses, and identifies existing knowledge gaps and structural impediments to improving the management of transition and transfer among congenital heart disease patients.

Descending aorta thrombus in a neonate mimicking coarctation of the aorta: Mechanical thrombectomy using the AngioJet® catheter

A 5‐day‐old neonate presented in shock, with signs and symptoms of severe coarctation of the aorta. He was diagnosed with a patent aortic arch, and a completely thrombosed abdominal aorta. The authors report the successful transcatheter removal of the entire thrombus using the AngioJet® Thrombectomy system. This represents the first published use of the AngioJet® catheter in the aorta of a pediatric patient.

Preoperative Evaluation of Adult Congenital Heart Disease Patients for Non-cardiac Surgery

Purpose of ReviewHighlight the extracardiac comorbidities that adult congenital heart disease patients and summarize the current recommendations for non-cardiac surgery.Recent FindingsAdult congenital heart disease patients are living longer, becoming more complex and developing adult comorbidities as they age. These patients have multiorgan involvement including higher prevalence of kidney disease and decreased lung function. Non-cardiac comorbidities can complicate surgery in this patient population. Most patients have non-cardiac surgery in community settings. These settings may increase adverse events during and in the post-operative period. Survival is improved when moderate and complex patients are seen in regional referral centers.SummaryImproved awareness of long-term complications of congenital heart disease and extracardiac comorbidities for adult congenital heart disease patients is needed. Appropriate care settings with both congenital heart disease expertise and adult subspecialty care reduces morbidity and mortality in these complex patients.

ADULTS WITH CONGENITAL HEART DISEASE: LOST IN CARE

Background: Transfer of congenital heart disease (CHD) care from the pediatric to adult setting has been identified as a priority and is associated with better outcomes. Many CHD patients may fail to transfer. The goal of this study was to assess the percentage of CHD patients who transferred out of

RED BLOOD CELL DISTRIBUTION WIDTH AND OUTCOMES IN FONTAN PATIENTS

Background: Fontan palliation results in late multi-organ co-morbidity. However, predictors of worse prognosis are lacking. We evaluated the association of red blood cell distribution width (RDW) with functional capacity and inflammatory biomarkers shown to be elevated in adult Fontan patients

BIOMARKER PROFILE IN ADULTS WITH FONTAN CIRCULATION

Background: Fontan palliation causes systemic changes in hemodynamics resulting in multi-organ co-morbid conditions. We evaluated biomarker levels representative of various systemic pathways in stable Fontan patients in comparison with healthy controls. Methods: We compared 23 stable Fontan