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Top 10 Points to Remember from ACHD
Guidelines
1. The care of ACHD patients should be coordinated by regional ACHD
centers of excellence, providing education, patient care and follow-up
by specialists for affected individuals.
2. Individual and family psychosocial screening and information should
be included in the care of ACHD patients.
3. Thorough clinical evaluation should be undertaken before anticipated
non-cardiac surgery, including ECG, chest x-ray, TTE, and blood tests.
4. Counseling before pregnancy is important to ensure that patients
understand the risks to both mother and baby, including the risks of
transmitting coronary heart disease to their offspring. Any noncardiac surgery in cyanotic patients, however minor, is potentially lifethreatening and should be coordinated with regional centers of
excellence.
5. Pacemaker implantation can be beneficial in ACHD patients, but
access may be challenging and implantation should be performed at
centers where staff is familiar with unusual anatomy of congenital
heart defects.
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Top 10 Points to Remember on ACHD
Guidelines
6. Closure of a secundum atrial septal defect, either percutaneously or
surgically, is indicated for right atrial and right ventricular
enlargement with or without symptoms.
7. Primary imaging and hemodynamic assessment of aortic stenosis
and aortic valve disease are recommended by echocardiographyDoppler to evaluate aortic stenosis or aortic regurgitation, left
ventricular size, function and mass, and dimensions and anatomy of
the ascending aorta and associated lesions.
8. Lifelong cardiology follow-up is recommended for all patients with
aortic valve disease.
9. All patients with tetralogy of Fallot should have regular follow-up with
a cardiologist with expertise in ACHD, the frequency of which may be
determined by the extent and degree of residual abnormalities.
10. There is a lack of scientific evidence demonstrating proven benefit
for IE prophylaxis, although prophylaxis is reasonable in patients with
CHD with the highest risk for adverse outcome from infective
endocarditis.
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