Coronary artery disease in adult patients with congenital heart disease

Objective: Improved surgical, interventional and pharmacological treatment for congenital heart disease in the past 30 years means that patients are now reaching an age in which typically coronary artery disease (CAD) occurs. We aimed to investigate whether GUCH patients (grown ups with congenital heart diseases) are at increased risk during CAD treatment. Methods: We retrospectively evaluated 39 out of 76 GUCH patients who were treated by operation or intervention for CAD between 1989 and 2006. Thirty-seven patients with persistent foramen ovale were excluded. Thirty of the 39 patients had a shunt at atrial level (ASD I, ASD II or partial anomalous pulmonary venous connection), 4 a ventricular septal defect, 3 tetralogy of Fallot, 2 congenital aortic valve and isthmus stenosis and 1 patient Ebstein anomaly. Results: Twenty-seven patients underwent coronary artery bypass grafting (CABG) and 12 a coronary intervention. Mean age was 61 (39–75) years. Seven patients had been operated on previously for their CHD, 4 of which were cyanotic diseases. Of the CABG patients one third had a prolonged postoperative course with the need for catecholamine support and/or IABP. Two patients died early postoperatively on the ICU and 1 patient late postoperatively. Conclusion: The number of GUCH patients with CAD will rise in the coming years. Surgical and interventional CAD treatment in these patients shows good results. Nonetheless, these patients have special problems, e.g. increased operative risk on reoperation and often right ventricular pressure and/or volume overload, that must be considered.