An increasing number of children with congenital heart disease are surviving into adulthood due to greatly improved surgical, medical, anaesthetic and intensive care over the last few decades. The survival of congenital patients into adulthood is now close to 85% in comparison to the 15% survival rate several decades ago. This new group of patients is now entering adulthood and will need regular monitoring and sometimes further surgical interventions may also be required.
With the exception of a few conditions, ligation of isolated
patent ductus arteriosus (PDA) and closure of isolated
atrial septal defects (ASD) and
ventricular septal defects (VSD), surgical treatment of congenital heart disease is more often palliative than curative. Repeated procedures and interventions are the norms as conduits, baffles, shunts and grafts become stenosed, blocked and incompetent with time. In addition to the medical and surgical issues, this growing population may also face specific social, psychological and behavioral problems throughout their life.
It is timely that adult congenital heart disease (ACHD) (also known as congenital heart disease in adults) is gaining recognition worldwide and in Singapore as an established subspecialty of cardiology.
The incidence of congenital heart disease (CHD) in Singapore is 0.81% of total live births based on the birth defect registry from 1994-2000. In Singapore, with an estimated population of around 4.3 million, the estimated number of adults with CHD would be in the region of 12,000 adults with an extra 300-320 cases added annually, assuming an annual birth of 37,000 – 40,000 newborns. It is estimated that in the next decade, the number of adult patients with congenital heart disease worldwide will exceed their paediatric counterparts.
Despite their improved life expectancy, congenital patients stepping into adulthood face many issues:
In the past, these adult patients were usually managed by paediatric cardiologists who, although excellent in interpreting and comprehending the underlying physiology and haemodynamics, were nonetheless ill-equipped in managing adult related problems like
coronary artery disease, pregnancy and contraception,
arrhythmias,hypertension. Research has shown that ACHD patients especially those of moderate to severe complexity do better when their care is centralised to a dedicated specialised ACHD unit.
Having survived into adulthood, ACHD patients are now facing a new set of challenges encompassing not only medical or surgical problems but extending to psychological, vocational and lifestyle issues. Congenital heart disease is a heterogenous condition with a wide spectrum of varying complexity and severity. Therefore, all ACHD patients (with the exception of those with mild isolated
valvular heart disease or those with repaired patent ductus arteriosus,
ventricular septal defect and
atrial septal defect) should be followed up in a specialised ACHD unit with a dedicated multidisciplinary team who can anticipate the various issues particular to each individual. Only then can we provide adequate care and work towards improving the clinical outcome of this special group of patients.
Diagnosis typically starts with a physical examination by a doctor, assessing your medical history and routine tests. Other tests recommended may include:
This programme was first started in 2003 and currently offers:
This clinic looks after patients with operated as well as unoperated congenital heart conditions from age 16 onwards. Adults with congenital heart disease need regular monitoring and sometimes further surgical interventions. It also screens suspected
Marfan patients and monitors ACHD patients closely during pregnancy
For more information on NHCS Adult Congenital Heart Disease (ACHD) Programme, visit
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