However, antibiotic prophylaxis against infectious endocarditis “is not recommended for nondental procedures [such as esophagogastroduodenoscopy or colonoscopy] in the absence of active infection,” the authors wrote in the guidelines.
Pregnancy and contraception require special consideration in women with CHD. With respect to contraception, oral estrogen-containing drugs are not recommended for patients at risk of thromboembolism, including those with pulmonary arterial hypertension or cyanosis related to an intracardiac shunt, according to the guidelines. Regarding pregnancy, patients are advised to consult with an adult CHD expert to determine a labor and delivery management plan prior to becoming pregnant.
In addition to the general recommendations for the care of adult CHD patients, the guidelines also include comprehensive information on the clinical features, diagnosis, treatment options, activity limitations, pregnancy risks, and preventive strategies related to specific lesions, such as atrial, ventricular, or atrioventricular septal defects; patent ductus arteriosus; left-sided heart obstructive lesions; right ventricular outflow tract obstruction; pulmonary artery hypertension/Eisenmenger physiology; and tetralogy of Fallot.
The adult CHD guidelines were developed in collaboration with the American Society of Echocardiography, the Canadian Cardiovascular Society, the Heart Rhythm Society, the International Society for Adult Congenital Cardiac Disease, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons.
While the recommendations are evidence based wherever possible, “unlike other ACC/AHA practice guidelines, there is not a large body of peer-reviewed published evidence to support most recommendations,” the authors wrote. For this reason, the evidence supporting many of the recommendations comes from the consensus of experts.
An increasing number of patients are now surviving into adulthood with complex cardiac anatomy and physiology. DR. WARNES