MONTREAL — The number of adults with congenital heart disease has soared by 85 per cent in a generation, an increase that reflects the startling advances in the detection and treatment of heart defects in children.
"This is one of the great success stories of 20th-century medicine," said Ariane Marelli, director of the adult unit for congenital heart disease excellence at the McGill University Health Centre in Montreal, whose team reported the findings.
Darren Prentice, a Montreal contractor, is one of those success stories.
He was first diagnosed with heart trouble at age 7 when a cardiac ultrasound revealed a mass of fatty tissue growing on his aortic valve, a condition known as severe congenital aortic stenosis. Shortly thereafter, he underwent open-heart surgery. Mr. Prentice underwent more surgery when he was 12 to have the valve replaced, then again at 17 when the plastic valve grew too small for his developing heart.
He was problem-free until last year when he suffered a bout of endocarditis (inflammation of the heart valve caused by a bacterial infection) and then life-threatening arrhythmias.
That required another open-heart procedure for a new valve and the installation of an implantable cardiac defibrillator.
"The amazing thing is people wouldn't know looking at me that I have heart disease -- not in a million years," Mr. Prentice, 37, said in an interview.
"I do physical work. I'm healthy. Unless you lift up my shirt and see all the scars, you have no idea."
Mr. Prentice said he is confident that advances in surgery and monitoring technology have ensured him of a long life, and he doesn't worry unduly about his increased risk of heart disease.
"The way I look at it is that my heart is under constant surveillance, so I'm in good hands. There are a lot of other people out there who are ticking time bombs and they don't have a clue."
In a paper published in today's edition of Circulation: Journal of the American Heart Association, Dr. Marelli and her team estimate that one in every 85 children and one in every 250 adults are now living with congenital heart disease.
That translates into about two million North Americans -- half of them adults. It also signifies that CHD, once considered strictly a pediatric condition, is now commonplace among adults.
That has significant implications because people with congenital heart disease, while they appear perfectly healthy, require life-long care and are at higher risk of developing other forms of heart disease including heart failure and arrhythmias (irregular heartbeat).
The new research, the first to try to pinpoint the number of people living with congenital heart disease, examined the number of patients diagnosed with CHD between 1985 and 2000 in Quebec.
During the study period, the incidence rate rose by 85 per cent among adults and 22 per cent in children. Significantly more females than males suffer from CHD, the paper reveals.
What is unclear, Dr. Marelli said, is whether the number of children being born with congenital heart disease is increasing.
Because more women older than 35 are having babies such an increase is likely, particularly when the risk of having a baby with Down syndrome (a condition that includes heart abnormalities) rises sharply.
At the same time, however, newer technologies allow the early detection of heart defects at earlier stages of pregnancy, and that may result in fetuses being aborted.
"We don't have good, updated information on absolute birth rates of babies with congenital heart disease," Dr. Marelli said.
What is much more clear, she said, is that improved surgical techniques have decreased mortality and prolonged life expectancy.
"This is one of the great success stories of 20th-century medicine," said Ariane Marelli, director of the adult unit for congenital heart disease excellence at the McGill University Health Centre in Montreal, whose team reported the findings.
Darren Prentice, a Montreal contractor, is one of those success stories.
He was first diagnosed with heart trouble at age 7 when a cardiac ultrasound revealed a mass of fatty tissue growing on his aortic valve, a condition known as severe congenital aortic stenosis. Shortly thereafter, he underwent open-heart surgery. Mr. Prentice underwent more surgery when he was 12 to have the valve replaced, then again at 17 when the plastic valve grew too small for his developing heart.
He was problem-free until last year when he suffered a bout of endocarditis (inflammation of the heart valve caused by a bacterial infection) and then life-threatening arrhythmias.
That required another open-heart procedure for a new valve and the installation of an implantable cardiac defibrillator.
"The amazing thing is people wouldn't know looking at me that I have heart disease -- not in a million years," Mr. Prentice, 37, said in an interview.
"I do physical work. I'm healthy. Unless you lift up my shirt and see all the scars, you have no idea."
Mr. Prentice said he is confident that advances in surgery and monitoring technology have ensured him of a long life, and he doesn't worry unduly about his increased risk of heart disease.
"The way I look at it is that my heart is under constant surveillance, so I'm in good hands. There are a lot of other people out there who are ticking time bombs and they don't have a clue."
In a paper published in today's edition of Circulation: Journal of the American Heart Association, Dr. Marelli and her team estimate that one in every 85 children and one in every 250 adults are now living with congenital heart disease.
That translates into about two million North Americans -- half of them adults. It also signifies that CHD, once considered strictly a pediatric condition, is now commonplace among adults.
That has significant implications because people with congenital heart disease, while they appear perfectly healthy, require life-long care and are at higher risk of developing other forms of heart disease including heart failure and arrhythmias (irregular heartbeat).
The new research, the first to try to pinpoint the number of people living with congenital heart disease, examined the number of patients diagnosed with CHD between 1985 and 2000 in Quebec.
During the study period, the incidence rate rose by 85 per cent among adults and 22 per cent in children. Significantly more females than males suffer from CHD, the paper reveals.
What is unclear, Dr. Marelli said, is whether the number of children being born with congenital heart disease is increasing.
Because more women older than 35 are having babies such an increase is likely, particularly when the risk of having a baby with Down syndrome (a condition that includes heart abnormalities) rises sharply.
At the same time, however, newer technologies allow the early detection of heart defects at earlier stages of pregnancy, and that may result in fetuses being aborted.
"We don't have good, updated information on absolute birth rates of babies with congenital heart disease," Dr. Marelli said.
What is much more clear, she said, is that improved surgical techniques have decreased mortality and prolonged life expectancy.
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