RESUMEN
Congenital heart diseases (CHD) are the most common types of congenital organ defects. Thanks to medical progress in congenital cardiology and heart surgery, most children with CHD reach adulthood. Despite primarily successful treatment residual and subsequent conditions as well as (non)cardiac comorbidities can influence the chronic course of the disease and lead to a higher morbidity and mortality. Adults with congenital heart disease (ACHD) in Germany are not tied to the healthcare structure despite the great need for aftercare. According to the results of the medical care of ACHD (MC-ACHD) study, ACHD centers and specialists in Germany are insufficiently perceived despite increased complication rates and the great need for specialist guidance. General practitioners and patients are not adequately informed about existing ACHD facilities. A better awareness of the ACHD problem should be created at the level of primary medical supply in order to optimize care and to reduce morbidity and mortality. Improved future-oriented patient care includes lifelong regular follow-up and the possibility of interdisciplinary, integrated medical care of CHD.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Cardiología , Cardiopatías Congénitas , Adulto , Cardiología/tendencias , Atención a la Salud , Alemania , Cardiopatías Congénitas/cirugía , HumanosRESUMEN
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for different forms of PH, and specifically address PH associated with congenital heart disease (CHD). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH in grown-ups with congenital heart disease (GUCH). This article summarizes the results and recommendations of this working group.
Asunto(s)
Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/terapia , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/terapia , Guías de Práctica Clínica como Asunto , Cardiología/normas , Alemania , Cardiopatías Congénitas/etiología , Humanos , Hipertensión Pulmonar/complicaciones , Pediatría/normas , Neumología/normasAsunto(s)
Amiloidosis/sangre , Amiloidosis/diagnóstico , Cardiomiopatías/sangre , Cardiomiopatías/diagnóstico , Medios de Contraste/farmacocinética , Gadolinio , Aumento de la Imagen , Imagen por Resonancia Magnética/métodos , Miocarditis/sangre , Miocarditis/diagnóstico , Miocardio/metabolismo , Miocardio/patología , Infecciones por Parvoviridae/sangre , Infecciones por Parvoviridae/diagnóstico , Parvovirus B19 Humano , Adulto , Femenino , Gadolinio/farmacocinética , Humanos , Músculo Esquelético/metabolismo , Músculo Esquelético/patología , Rabdomiólisis/sangre , Rabdomiólisis/diagnósticoAsunto(s)
Cateterismo Cardíaco , Embolia Paradójica/etiología , Embolia Paradójica/prevención & control , Foramen Oval Permeable/terapia , Embolia Intracraneal/etiología , Embolia Intracraneal/prevención & control , Adolescente , Adulto , Anticoagulantes/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Prevención Secundaria , Adulto JovenRESUMEN
We report the rare case of a 55-year-old female with massive eosinophilic myocarditis and severe, however reversible, impairment of left ventricular function. The patient presented with reduced physical condition, progressive dyspnea on exertion and peripheral edema. The white blood count revealed a leukocytosis and markedly elevated peripheral blood eosinophilics (48.8%). An endomyocardial biopsy demonstrated massive myocardial infiltration with eosinophilic granulocytes and necrosis. The symptoms and laboratory parameters indicate the presence of a hypereosinophilic syndrome. The differential diagnosis of a Churg-Strauss syndrome is discussed. Medical heart failure treatment according to international guidelines and an immunosuppressive treatment with prednisolone (Decortin H) 1.5 mg/kgBW) were initiated. This therapy led to a dramatic reduction of the eosinophilic granulocyte count and normalization of the peripheral blood count, which correlated with a significant improvement of clinical symptoms. Consistently, an increase of left-ventricular function was observed. Upon successive dose reduction to a maintenance dosage of 10 mg prednisolone, the patient's clinical status and peripheral blood count remained stable.