Medical Issues
Medical Surveillance
A congenital abnormality of the heart constitutes an indication for close and competent medical care throughout the person’s life. This is essential for every person including those in whom the abnormality is mild, requiring no surgery and in all those who have been successfully operated upon in the past. This is important for the following reasons:
- With time and with growth cardiac status may change and conditions, such as arrhythmias (irregular heart beat), heart muscle thickening, or heart failure may supervene.
- Long term post-operative alterations of cardiac tissues, artificial valves, may become aggravated.
- Changes in general health, such as obesity or hypertension may adversely affect cardiac functions.
- Psychosocial status may adversely affect quality of life.
- Changes in life style may involve excessive physical activity.
- Unhealthy habits, such as smoking, drinking or recreational drug taking may add new risks.
- Almost all patients with congenital heart disease are at risk of blood stream infection.
- All patients with congenital heart disease must receive informed counsel regarding reproductive care and the risk of congenital heart disease in their offspring.
- Consistent and unremitting follow-up may lead to early preventive interventions.
Selected References for Medical Issues
Bacterial endocarditis
In the intact circulation bacteria entering the bloodstream are rapidly eliminated and cause no permanent harm. However in the presence of intracardiac abnormalities, such as abnormal valves or septal defects , bacteria will become attached to these sites and cause inflammatory lesions, which in turn may initiate clots and infected emboli traveling to other parts of the circulation with grave consequences . Depending on the infective organisms such blood stream infections may spread rapidly and become fatal, while less aggressive organisms may persist for weeks and months causing progressive damage.
Blood stream infections are preventable . The routine practice of antibiotic therapy for dental work has been conscienciously practiced by dentists and dental technicians, who usually ask ,but are not always correctly advised, by the patient. Silent or undiagnosed abnormalities, such as mitral valve prolapse, are now predominant among patients with blood stream infections.
Special emphasis must be placed on adults with congenital heart disease , many of whom remain at increased risk even after successful surgery. The patients must take responsibility to ascertain their own risk status and advise their dentists and other practitioners accordingly.
Emphasis is usually placed on oral health but it is necessary to remember other potential sources of blood stream infection : some of these result from fad practices in the current young population, such as body piercings, especially when performed by ignorant practitioners. Intravenous drug use presents a specially notable problem .
The implications for the prevention of this grave complication of operated and unoperated congenital heart disease are obvious : the appropriate education of the parents, the adolescent and the continued emphasis on precautions in the adult by all care takers.