P988 The newly discovered congenital heart disease in grown-up patients: untimely diagnosis or echocardiographic casuistry?

Abstract

Abstract Purpose of the study. Evaluation of the reasons for the untimely diagnosis of congenital heart disease (CHD) in adults and elderly patients. Material and methods. 30000 people over the age of 25 who underwent transthoracic and transesophageal echocardiography were examined. Results CHD for the first time were revealed in 417 of 30000 patients (1,39%) including 41 of 5346 patients over 60 years of age (0,77%). The most often CHD was atrial septal defect (ASD) – 179 patients, and ventricular septum defect (VSD) was significantly less diagnosed (48 cases). In 98 cases, an aortic valve bicuspidy was identified with hemodynamically significant aortic valve stenosis and / or insufficiency. Coarctation of the aorta was detected in 25 patients, in 16 cases it was combined with a bicuspid aortic valve. The diagnosis of Ebstein"s anomaly (AE) was established in 16 patients, patent ductus arteriosus (PDA) in 15 patients, isolated pulmonary artery stenosis - 12, congenitally corrected transposition of the great arteries (CCTGA) - 6, tetralogy of Fallot - 5, congenital aneurysm of the sinus of Valsalva (CASV) - 5, congenital aneurysm of the ascending part and the arch of the thoracic aorta - 4, Lutembacher syndrome - 2, congenital mitral insufficiency - 2, mesocardia - 2 cases. In patients with CHD over 60, secondary ASD prevailed (28 observations); less frequently were discovered VSD (4), CCTGA (3), CASV (4), PDA (1), AE (1). Conclusion Untimely detection and difficulties in primary diagnosis of CHD in adults and elderly patients can be due to established diagnostic stereotypes, when the results of clinical observation and instrumental examination were interpreted in favor of manifestations of coronary artery disease, arterial hypertension, chronic heart failure, acquired valvular heart disease, cardiomyopathies etc. In addition, overestimation of concomitant age-related structural and functional changes of the heart and improper medical monitoring may be important.