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Congenital heart disease
Management of adults with cyanotic congenital heart disease
  1. Erwin Oechslin
  1. Correspondence to Erwin Oechslin, Toronto Congenital Cardiac Centre for Adults, University of Toronto, Peter Munk Cardiac Centre, University Health Network/Toronto General Hospital, 5 NUW—519, 585 University Ave, Toronto, ON M5G 2N2, Canada; erwin.oechslin{at}

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Learning objectives

  • To appraise the challenges of a chronic, multisystem disease and to integrate treatment strategies preventing harm to the patient.

  • To formulate a rational approach to the diagnosis and treatment of adults with cyanotic congenital heart disease.

  • To recognize the importance of a systematic, multidisciplinary team approach by experts to provide excellent care for adults with cyanotic congenital heart disease.

Curriculum topic: congenital heart disease

Great advances in medicine, in particular surgical and interventional advances, for the treatment of cyanotic congenital heart disease (CCHD) and early detection of large septal defects, have turned cyanotic children into acyanotic survivors and revolutionised survival of these patients.w1–6 Persistence of cyanosis is the exception in patients with unrepaired or palliated CCHD (eg, tetralogy of Fallot, transposition complexes, double outlet right ventricle, univentricular hearts) or undetected septal defects with Eisenmenger physiology in western countries or in immigrants from countries where surgical repair of congenital heart disease (CHD) is not available or not affordable.

Understanding the underlying anatomy, pathology and pathophysiology is fundamental for the optimal management of patients with CCHD to avoid errors and mistakes. Care for children with CCHD is the domain of paediatric cardiologists, who have to be fully integrated into a multidisciplinary team of experts caring for these cyanotic patients after their graduation from paediatric cardiology and after proper transition and transfer to adult care.w7 w8

This article addresses challenges in the management of cyanotic patients surviving into adulthood. Longevity of patients with CCHD is better than assumed, and survival into adulthood is not uncommon.1–3 w9 w10 The complication rate is usually low during the first 30 years, but complications and the attrition rate start in the third or fourth decades of their life. Complications and death can be triggered by inappropriate therapeutic measures. The most common mistakes and avoidable complications are based on poor appreciation …

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  • Contributors EO undertook the conception and design of this manuscript, and is the only author.

  • Competing interests In compliance with EBAC/EACCME guidelines, the authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. The author has no competing interests.

  • Provenance and peer review Commissioned; externally peer reviewed.

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