The woman with congenital heart disease

Abstract

Congenital heart disease, the main concern of paediatric cardiology, now presents problems for adult cardiologists, untrained and uninterested in such patients. Paediatric cardiology, stimulated by the challenge of cardiac surgery for congenital anomalies, has focused on anatomical disorders, changing nomenclature (often), embryological ‘myths’ and the results of various and many remarkable surgical feats. The latter’s success has created a new medical community — the ‘grown-up’ congenital heart patients — the GUCH. The patients’ gender has not concerned anyone. Whether it influences outcomes or natural history in congenital heart disease is neither known nor discussed. Since the opening of the adolescent cardiac unit in 1975 at the National Heart Hospital, which expanded into the GUCH unit now in the Royal Brompton, a database has been developed over the 20 years. This contains information on more than 5000 GUCH patients, and provides the basic data for this lecture. As a specialist unit within Cardiology there is bias for referral of complex problems which influence statistics, sometimes giving too gloomy a picture. Certainly the care of and provision for GUCH patients includes all teenagers (adolescents) and adults for their full life span, irrespective of gender. Whether gender influences outcomes and problems will be examined. The data on prevention and treatment of coronary heart disease and hypertension in men do not automatically apply to women. A woman is not an honorary man. By definition in the Shorter Oxford English Dictionary (1956) a woman is ‘an adult female human being’, additionally with secondary definitions ‘a female servant’, ‘a mistress’, ‘a wife’ and ‘the reverse of a coin referring to Britannia’. A female belongs to the sex which bears offspring — it is this characteristic which makes a woman different from a man. A child becomes an adult when reaching a particular age, which varies from country to country, defined for the law, for health management, government, etc. Adolescence and adolescents are not recognised officially in the United Kingdom’s Department of Health; one is either a child or an adult at age 16 years. Since a female can and does bear children before the age of 16 years it is difficult to know when womanhood begins from the definitions.