Congenital heart disease refers to the structural or functional abnormality of the macrovascular in the heart or thoracic cavity caused by the failure of the formation of the heart and large blood vessels during the embryonic development or the abnormal closure of the heart or the closure of the channel after birth. In the past few years, a new and broader definition of structural heart disease has been gradually proposed. Structural heart disease narrowly refers to the pathological and physiological changes of the heart caused by abnormal anatomical structures in the heart, including congenital heart disease. A few decades ago, congenital heart disease was considered as a pediatric disease, because most patients with severe lesions rarely survive to adulthood. Due to recent advances in echocardiography, anesthesia, intensive care, percutaneous intervention, especially cardiac surgery in recent decades, the treatment and intervention strategies for congenital heart disease in children have been greatly improved, a fatal defect in childhood can now be successfully repaired or alleviated. Because of these successes, more than 90% of congenital heart disease patients are expected to survive to adulthood, which has led to emerge a new population: adult patients with congenital heart disease. Adult congenital heart disease patients are different from children. Pulmonary hypertension leads to right heart failure and eventually progresses to whole heart failure. The appearance of Eisenmenger syndrome leads to severe cyanosis and worsening of the disease. At present, the continuous development of mechanical assisted circulation support devices and heart or cardiopulmonary transplantation technology has increased the survival rate of end-stage adult congenital heart disease patients with heart failure. The high incidence of cardiovascular events in pregnant patients requires comprehensive multidisciplinary team care and early coordination planning for delivery, including early counseling for pregnancy-related risks, close monitoring of cardiac function and regular scan of fetal assessment. The prenatal and postpartum integrated diagnosis and treatment model and the development of intrauterine treatment technology reduce the incidence of congenital heart disease in adults from the source through fetal intervention. Other complications such as arrhythmia, infective endocarditis, cerebrovascular accidents, and other medical underlying metabolic diseases also challenge future diagnosis and treatment. The incidence and epidemiology of adult congenital heart disease, pulmonary hypertension and end-stage heart failure complications, as well as prenatal and postpartum integrated diagnosis and treatment and intrauterine treatment are summarized in this review.
We reported a case of a 61-year-old female patient, six years status post her last cardiac surgery, who was admitted with a chief complaint of bilateral lower extremity edema for over a year, which had acutely worsened with associated chest pain for two days. The patient had a complex cardiac surgical history: 12 years prior, she underwent double valve replacement (aortic and mitral) plus tricuspid valvuloplasty for mitral valve prolapse with severe regurgitation and moderate-to-severe aortic regurgitation. Nine years ago, she underwent bioprosthetic mitral valve replacement and vegetation removal for prosthetic valve vegetation with severe regurgitation. Six years ago, she underwent a transapical transcatheter mitral valve replacement and mitral balloon valvuloplasty due to prosthetic mitral valve prolapse with severe regurgitation. Following evaluation during this admission, she successfully underwent a valve-in-valve transcatheter aortic valve replacement (ViV-TAVR). The patient had an uneventful postoperative recovery. This case report aims to explore the clinical strategy and application of the ViV-TAVR technique for managing bioprosthetic valve failure in patients with a history of complex valvular surgeries.