Management of Acute Heart Failure

Abstract

Survival of patients with congenital heart disease has tremendously improved in the last two decades. More than 90% of patients with congenital defects operated during infancy reach adulthood. On the other hand, depending on the anatomic complexity, the surgical history, and the presence of significant residual defects, a not negligible proportion of ACHD patients may develop heart failure (HF). The incidence rate of heart failure increases overtime, particularly in specific populations, such as those who had undergone Fontan palliation or have a morphologic right ventricle. Prognostic stratification and management of ACHD patients with HF are particularly challenging owing to the paucity of evidences specifically generated on this population. However, patterns of clinical presentation, in many ways, reproduce those of non-congenital patients, i.e., acute vs chronic HF, reduced vs preserved EF HF, and so on; therefore, we can reasonably transfer some of the models of management of the acquired heart disease to this population. On the other hand, pathophysiologic peculiarities of ACHD group of patients have to be constantly kept in mind in modulating therapies and interventions, in order to avoid potential detrimental effects. In this chapter, we summarize the epidemiologic, pathophysiologic, and management main topics of acute HF in ACHD patients.