Congenital heart diseases in aged patients: clinical features, diagnosis, and therapeutic indications based on the analysis of a twenty five-year Medline search.
OBJECTIVE
The increasing aging of the population make congenital heart disease more likely to be found in aged patients. No systematic data exist on epidemiology, diagnosis, and therapy in this complex class of patients. The purpose of this study was to provide specific clinical, diagnostic, and therapeutic information concerning patients over 65 with congenital heart disease (CHDs) and to identify the most frequent CHDs in such class of patients.


METHODS
A Medline search was performed to include articles related to congenital heart disease in patients over 65 in worldwide literature from January 1977 to January 2004. Follow-up studies of old, operated CHDs were excluded. The selected papers were divided and numbered on the basis of key words in the title and contents into general, diagnostic, and therapeutic topics.


RESULTS
One thousand ninety-five articles met the search criteria. Atrial septal abnormalities, coronary artery anomalies, bicuspid aorta and congenital aortic valve stenosis, and patent ductus arteriosus resulted in the most cited CHDs in the elderly. Clinical manifestations included syncope, supraventricular/ventricular arrhythmias, symptoms of chronic pulmonary hypertension, and congestive heart failure. Echocardiography for the most frequent CHDs and computed tomography and magnetic resonance for complex cases were the main diagnostic tools (277, 104, and 110 citations, respectively). Catheterization plays a marginal role (68 articles). Age is not considered a contraindication to interventions; surgical and endovascular therapy appeared to be similarly useful in managing the most frequent CHDs (88 and 63 citations, respectively), whereas medical treatments were selected for most complex CHDs (71 citations).


CONCLUSIONS
Patients with CHDs, especially those with low mortality in childhood, are more frequently reaching old age. New imaging techniques and endovascular treatments seem useful in the challenging management of CHDs in aged patients.
Rigatelli
Gianluca
G
EndoCardioVascular Therapy Research, Via Tito Speri, Verona, Italy. jackyheart@hotmail.com
Rigatelli
Giorgio
G
D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D016239:MEDLINE; D008279:Magnetic Resonance Imaging; D014057:Tomography, X-Ray Computed