Follow-up of patients born with congenital heart disease:
The term ‘congenital heart disease’ is a very broad one and refers to any defect of the structure of the heart present from birth. Some abnormalities are minor e.g. small holes in the heart, which in some instances even settle on their own without the need for any surgery or intervention. There are, however, other conditions which are much more complex and for which babies or young children often need one or more operations or interventions to correct the abnormality.
Up until a few decades ago, many babies born with the more complex conditions would die at a very young age. However, thanks to surgical advances, it is possible for most of these children to have their heart condition corrected allowing them to lead a normal life and to grow into adulthood, and in case of women, even to become pregnant and have their own children. Despite all this, it is worth remembering that the heart has been operated on and it is thus very important for these patients to have regular follow-ups with doctors trained in managing these heart conditions.
We believe such follow-up should continue even when the patient grows up and becomes an adult. It is for this purpose that for several years, we have been running a GUCH clinic – GUCH being short for Grown-up Congenital Heart Disease. Apart from outpatient visits, we also perform some tests from time to time. The main tests are:
a) Echocardiogram – this is a heart ultrasound which allows us to see inside the heart. We can assess the function of the different heart valves and also the pumping function of the heart.
b) ECG – this is an electrical tracing of the heart and is usually done when the patient comes to see us in clinic. It gives us information on the electrical activity in the heart.
c) Chest X–ray – it allows us to assess the size of the heart and the vessel coming off it.
d) 24hr ECG (Holter) – this test is essentially a continuous ECG recording for a period of 24 hours which allows us to pick up any fast or slow heart rhythms even when they are not causing symptoms, as we know these might happen more often in people who have had heart surgery
e) Stress test (or exercise tolerance test) – this involves the patient walking on a treadmill for some minutes and helps us know how much exercise the patient can do as this is an indicator of how well his/her heart is functioning.
f) 24 hr blood pressure monitor – a way of assessing blood pressure control over a period of a day and night
g) Cardiac MRI / cardiac CT scan – in a small number of patients, we might need more detailed assessment of the anatomy of the heart and vessels by means of an MRI or CT scan
Thanks to such follow-up, we can pick up any problems at an early stage and act upon them if needed.