«cardiopathies congénitales et travail" Dr Iserin Unité des cardiopathies congénitales de l adulte, HEGP et Necker

Transcription

1 «cardiopathies congénitales et travail" Dr Iserin Unité des cardiopathies congénitales de l adulte, HEGP et Necker

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3 Les adultes plus ou moins complexes que les enfants? En % des vivants complexes sont des adultes.

4 age moyen (BACH) = 42 yrs (16-64) Bethesda 32: Care of the Adult with CHD Task Force 1: J Am Coll Cardiol 2001

5 Changing Mortality in Congenital Heart Disease Distribution of Age at Death in Patients With Congenital Heart Disease in 1987 to 1988 and 2004 to 2005 Histogram bars depict the proportion of all deaths (x-axis) according to age at death (y-axis) Paul Khairy, JACC 2010

6 Mortality per defect in 5 years follow-up starting with a median age of 27 years n % /1000 py ASD VSD Fallot CoA TGA Marfan Fontan Cyan

7 Lifetime cumulative incidence of atrial arrhythmias in ACHD Bouchardy, J. et al. Circulation 2009;120: Copyright 2009 American Heart Association

8 HR for outcomes in ACHD with and without atrial arrhythmias (AA) Bouchardy, J. et al. Circulation 2009;120: Copyright 2009 American Heart Association

9 Employment in Adults With Congenital Heart Disease Arch Pediatr Adolesc Med Patient Characteristics* Date of download: 1/18/2013 Copyright 2012 American Medical Association. All rights reserved.

10 Employment in Adults With Congenital Heart Disease Effects of Variables on Employment Status Based on Multiple Regression Analysis* Copyright 2012 American Medical Date of download: 1/18/2013 Association. All rights reserved.

11 Social Burden and Lifestyle in Adults With Congenital Heart Disease American Journal of Cardiology 2012 social life and lifestyle in adult patients. Random sample (n = 1,496) from the CONgenital CORvitia (n = 11,047) Questionnaire on educational attainment, employment and marital statuses, and lifestyle (response 76%). Young (<40-year-old) patients with CHD : lower education ( [OR 1.6 / men 1.9 / women), p <0.05 for the 2 comparisons) more often unemployed (adjusted ORs 5.9/men and 2.0 / women)

12 Melle C 35 years, policewoman tetralogy of Fallot

13 Sudden death???? VT 2% / years of follow up

14 réoperations? Fallot classique, sans autre anomalie associées opérée en Si on extrapole plus de la moitié des patients seront vivants sans réoperation après 40 ans Hickey EJ, et al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothorac Surg (2008)

15 Mr L, 25years old Operated at age 2 fore coarctation repair Always had normal blood pressure a rest but SBP on exercice 285. Resting atypical chest pain. Rarm est à 140/70 L arm 130/59 au bras gauche LL 132/69 au membre inférieur droit

16 L Heart spectrum

17 Pruner/ Tree Surgeon

18 Medical therapy and stenting

19 40 years born with TGA Mustard Senning

20 Asymptomatic but.

21 Sells cars and trucks.

22 Flutter post-opératoire

23 For Class 2 drivers DVLA recommends arrhythmia control for 3 months, while the USA stipulate only 1 month as with Class 1 drivers. In the ESC guidelines a resumption of driving is permitted once the arrhythmia is controlled. Additional requirements from the ESC recommendations for Class 2 licence holders include the LVEF should be >40% (this is also recommended in the UK guidelines), May reflect the fact that arrhythmias are more likely to cause haemodynamic compromise in patients with severe LV systolic dysfunction. Driving and arrhythmia: a review of scientific basis for international guidelines EHJ 2013

24 Mrs L 44 ans Eisenmenger Syndrome (HTAP) Deep Cyanosis Wants to work taxi everyday everyone is scarred.. Letter

25 Eisenmenger Indication à fermer le shunt Contre -Indication à fermer le shunt De 0 à 6 mois A partir de 2 ans

26 in France : 743,62. AAH : Montant

27 Can we do any better? Preventive strategy Transition clinic for guidance about employment and physical activity Simple lesions : no technical problems but potentially adminstrative problems complex lesions and repair : orientation towards sedentary work. Communication between cardiologist and occupational health doctor nearly always improves the situation