Treatments and Services
The EACH Center provides a multidisciplinary approach to late-onset complications of CHD that includes collaboration with congenital heart surgeons, congenital cardiologists, electrophysiologists, interventional cardiologists and structural heart disease specialists, advanced heart failure specialists, hepatologists, neuropsychologists, contraceptive counselors, obstetricians and maternal-fetal medicine specialists, pulmonologists, geneticists, and hematologists.
Medical Treatments
Just as surgical innovations helped initially to save the lives of people born with heart defects, medical and therapeutic advances are now helping adult patients with CHD who receive care in specialized adult CHD (ACHD) centers to live the healthiest lives possible. The ACHD patient requires thoughtful and collaborative care from a multidisciplinary team to facilitate early recognition of problems, initiation of appropriate treatment and anticipation of long-term complications that may prohibit advanced therapies and greatly impact overall quality of life.
EACH provides comprehensive medical services for adults with CHDs, including preventive care and management of the following:
*(Atrial Flutter, Atrial Fibrillation, 1:1 Atrial Tachycardia, Sick Sinus Syndrome, Supraventricular Tachycardia [SVT], Ventricular Tachycardia, Sudden Cardiac Death)
• Anti-tachycardia pacemakers
• Bi-ventricular pacemakers
• Implantable cardiac defibrillators (ICDs)
• Cardiac ablation
• The use of air bubble filters on all intravenous lines to prevent air embolism with flushes and infusions
• Avoiding routine phlebotomy by monitoring blood count and symptoms
• Observation for anemia and thrombocytopenia
• Management of hemoptysis
• The use of antibiotics before all dental and surgical procedures (SBE prophylaxis) only for select CHD patients
• Early intervention for fever, especially in the absence of other symptoms or illnesses, for patients at risk of endocarditis (for example, blood tests may be requires prior to the initiation of antibiotics)
• Medication therapy
• Cardiac re-synchronization therapy (CRT)
• Ventricular assist devices (VADs) [see surgical treatments]
• Cardiac transplantation [see surgical treatments]
Surgical Treatments
Our surgeons perform approximately 100 adult CHD (ACHD) surgeries per year and regularly achieve survival outcomes that rank among the best in the nation. In addition, our surgical team has been at the forefront of developing and implementing improved techniques for re-do sternotomy, complex valve and conduit replacements, aortic root replacements and Fontan conversions.
The left and right side of the heart are separated by a wall called the septum. Some people are born with a hole in either the upper septum (atrial septal defect) or the lower septum (ventricular septal defect). Untreated, these defects may cause a variety of serious conditions. While the majority of these defects are closed in childhood, many go undiagnosed and require repair in adulthood.
Many CHDs involve abnormalities of the heart valves. Regurgitation is a condition in which the valve does not close completely, allowing blood to leak backward through the valve. Stenosis is a condition in which the valve does not open completely, thus restricting blood flow. Children with defective valves generally undergo replacement surgery, but the replacement valve often deteriorates with age. As a result, many adult patients require surgical valve repair or replacement.
To learn more about valve disorders, visit the Structural Heart pages.
Narrowed pulmonary valves are often removed in childhood to allow blood to flow into the lungs without obstruction. Despite the resulting regurgitation (backward flow of blood), this procedure generally provides for an excellent quality of life in childhood. However, over time, the regurgitation leads to complications that must be corrected. Pulmonary valve replacement is often required to restore normal cardiac anatomy.
Many children with complex single-ventricle CHDs undergo a Fontan operation to correct their disorder. Unfortunately, over many years, the original Fontan operation often results in unfavorable blood flow patterns and abnormal heart rhythms. While the original Fontan procedure has been modified to correct identified flaws, many patients who underwent the original procedure require conversion to the modified Fontan to correct the associated complications.
Heart transplantation remains an excellent option for patients who have exhausted all medical and surgical therapies for heart failure. Emory surgeons have performed more than 550 adult heart transplant surgeries since 1985.
Ventricular assist devices (VADs) are a type of mechanical circulatory support device that have been in use for more than 25 years primarily in patients with heart failure who are awaiting transplantation.
In recent years, newer models have been developed for use as a permanent or “destination” therapy. These newer models are used in patients for whom transplantation is not an option. While these devices are not yet widely used in the adult congenital population, we expect it to play a greater role in the future as the devices and procedures become more effective.
