Andersons pediatric cardiology 2139
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PreparingtheYoungAdultWith
ComplexCongenitalCardiacDisease
toTransferFromPediatrictoAdult
Care
PhilipMoons
Abstract
Morethan90%ofchildrenbornwithcongenitallymalformedheartsnow
survivetoadultlife,asaresultofthespectacularachievementsofpediatric
cardiologyandsurgeryoverthepasthalf-century.Thishascreatedanew
andgrowingpopulationofadultswhooftenhavecomplexcongenital
cardiacmalformationsthatareunfamiliartoconventionallytrainedadult
cardiologists.Theneedforanintegratedstrategyofcareforsuchpatients
withcongenitallymalformedhearts,whousuallyrequirelife-longmedical
care,hasbeenrecognized.Severalpanelsofinternationalexpertshave
providedframeworksforprovisionofservices.Theseshareanumberof
commonrecommendations.First,allrecognizetheneedformanagementin
anadultenvironment,astheaverageageofthepopulationofadultswith
congenitalcardiacdiseaseincreases.Second,allrecommendahierarchical
structureforcare,withspecialistcentersprovidingafullrangeof
diagnosticfacilitiesandtreatmentsinteracting,andoftensharingcare,with
otheradultcardiacunits.Third,allaccepttheneedfortrainingofanew
subspecialtyofmedicalandalliedhealthpractitionerswithexpertiseinthe
managementofcongenitalcardiacdiseaseandthecareofadults.
Throughoutchildhood,patientswithcongenitalcardiacdiseasearetreated
andfollowed-upatpediatriccardiologycenters.Whentheybecomeadults,
itisadvocatedthattheirmedicalsurveillanceandfollow-upcareis
transferredtoadult-focusedfacilities.Thischapterdefinestransferand
transition,describesthekeyissuesintransition,andexplainsthecore
componentsofeffectivetransitionprograms.
Keywords
Transfer;transition;adolescents;youngpersons
Morethan90%ofchildrenbornwithcongenitallymalformedheartsnow
survivetoadulthood,asaresultofthespectacularachievementsofpediatric
cardiologyandsurgeryoverthepasthalf-century.1,2Thishascreatedanewand
growingpopulationofadultswhooftenhavecomplexcongenitalcardiac
malformationsthatareunfamiliartoconventionallytrainedadultcardiologists.
Theneedforanintegratedstrategyofcareforsuchpatientswithcongenitally
