Coronary Artery Disease Risk in Patients with Congenital Heart Disease
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PEDIATRICS (S GIDDING, SECTION EDITOR)
Coronary Artery Disease Risk in Patients with Congenital Heart Disease Meryl S. Cohen
# Springer Science+Business Media New York 2014
Abstract As the congenital heart disease population ages, coronary artery disease may emerge as a significant comorbidity. This presents a new problem to cardiologists caring for an aging population that did not previously exist. Various congenital heart defects are likely at higher risk for the development of coronary artery disease including congenital coronary artery anomalies, defect with abnormal coronary artery connections to the ventricles, and conotruncal anomalies that require coronary artery reimplantation. The impact of coronary artery disease on this population remains to be seen. Keywords Congenital heart disease . Coronary artery disease . ALCAPA (Anomalous left coronary artery from the pulmonary artery) . AAOCA (Anomalous aortic origin of the coronary artery)
Introduction Congenital heart disease (CHD) is the most common congenital defect in children. With the innovative treatment strategies that have been developed over the past 50 years, the majority of children with CHD will survive into adulthood. Presently, there are over one million adults in the US living with CHD and this number continues to grow [1]. Concerns about this population have transitioned from improving surgical survival to long-term issues including neurodevelopmental outcome, quality of life and assessment for the common diseases of This article is part of the Topical Collection on Pediatrics M. S. Cohen (*) Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 34th Street and Civic Center Blvd, Philadelphia, PA 19104, USA e-mail: [email protected]
adulthood including hypertension, obesity, and coronary artery disease [2]. Hospital admissions for adults with CHD have doubled over the past decade and resource utilization continues to increase exponentially [3]. Within the CHD spectrum, there are particular cardiac defects that are likely at higher risk for the development of coronary artery disease because of intrinsic or surgical coronary abnormalities [4, 5]. Primary congenital coronary anomalies include anomalous coronary artery from the pulmonary artery, anomalous aortic origin of a coronary artery, coronary artery atresia and coronary artery fistulae. Many heart defects have abnormalities of the coronary arteries; pulmonary atresia with intact ventricular septum and hypoplastic left heart syndrome may have associated coronary cameral fistulae while transposition of the great arteries and other conotruncal anomalies may have abnormal origin and course of the coronary arteries. Surgical intervention may impact coronary blood flow for these lesions. Finally, as patients with CHD age, they may be at risk for the development of atherosclerotic coronary artery disease. This review will discuss the association of coronary artery disease in patients with CHD.
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