Top 10 Points to Remember from ACHD Guidelines

1. Top 10 Points to Remember from ACHD Guidelines 1. The care of ACHD patients should be coordinated by regional ACHD centers of excellence, providing education, patient care and follow-up by specialists for affected individuals. 2. Individual and family psychosocial screening and information should be included in the care of ACHD patients. 3. Thorough clinical evaluation should be undertaken before anticipated non-cardiac surgery, including ECG, chest x-ray, TTE, and blood tests. 4. Counseling before pregnancy is important to ensure that patients understand the risks to both mother and baby, including the risks of transmitting coronary heart disease to their offspring. Any non-cardiac surgery in cyanotic patients, however minor, is potentially life-threatening and should be coordinated with regional centers of excellence. 5. Pacemaker implantation can be beneficial in ACHD patients, but access may be challenging and implantation should be performed at centers where staff is familiar with unusual anatomy of congenital heart defects.

2. Top 10 Points to Remember on ACHD Guidelines 6. Closure of a secundum atrial septal defect, either percutaneously or surgically, is indicated for right atrial and right ventricular enlargement with or without symptoms. 7. Primary imaging and hemodynamic assessment of aortic stenosis and aortic valve disease are recommended by echocardiography-Doppler to evaluate aortic stenosis or aortic regurgitation, left ventricular size, function and mass, and dimensions and anatomy of the ascending aorta and associated lesions. 8. Lifelong cardiology follow-up is recommended for all patients with aortic valve disease. 9. All patients with tetralogy of Fallot should have regular follow-up with a cardiologist with expertise in ACHD, the frequency of which may be determined by the extent and degree of residual abnormalities. 10. There is a lack of scientific evidence demonstrating proven benefit for IE prophylaxis, although prophylaxis is reasonable in patients with CHD with the highest risk for adverse outcome from infective endocarditis.