Author + information
- Curt J. Daniels, MD,
- Michael J. Landzberg, MD and
- Robert H. Beekman III, MD∗ ()
- ↵∗ACC Adult Congenital and Pediatric Cardiology Section, Division of Cardiology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio 45229
The term “structural heart disease” entered the adult cardiology lexicon in 1999 and currently encompasses the base of knowledge and competencies surrounding noncoronary cardiac procedures such as transcatheter aortic valve replacement (TAVR), percutaneous mitral repair, and left atrial appendage exclusion. We and others have detected an indiscriminant trend, however, to use the phrase “structural heart disease” (SHD) to include congenital heart disease (CHD). The recent editorial by Drs. Yadav, Halim, and Vavalle (1) in which the authors make an impassioned plea for improved adult SHD interventional training is a recent example, because throughout the paper, SHD and CHD are conflated. We wish to point out the important distinction between SHD and CHD in current vernacular, so as to avoid further sensed competition and to promote best patient outcomes across all cardiac specialties.
CHD is an important and distinct subset of SHD. First, it challenges clinicians with a combination of complex pathophysiology, anatomy, and natural and unnatural history that rarely is incorporated into traditional cardiovascular medicine training. Second, many types of CHD can be treated with a well-developed array of interventional transcatheter therapies that are unique to the field of CHD and that continue to evolve along their own distinct pathway outside of SHD. Indeed, percutaneous treatment of CHD is a mature specialty. Third, patients with CHD benefit from established clinical and training programs with dedicated focus on their complex CHD structural lesions. There is an entire body of knowledge in the field of pediatric and adult CHD (ACHD) that addresses congenital anatomy, pathophysiology, percutaneous and surgical palliation, and lifelong cardiovascular issues that span the spectrum of cardiovascular medicine (heart failure, arrhythmias, cardiopulmonary hemodynamics, valvular heart disease, aortic disease, peripheral and pulmonary vascular disease). Just as there is requisite competency in critical understanding of aortic valve anatomy, physiology, and indications for replacement before performing the TAVR procedure, CHD interventionalists must be fully competent in critical aspects of CHD before performing procedures. Finally, CHD is its own specialty and is recognized as such. The American College of Cardiology provides a professional home to its pediatric and ACHD care providers within the Adult Congenital and Pediatric Cardiology Section, founded in 2005. The American Board of Internal Medicine has established ACHD board certification, and the Accreditation Council for Graduate Medical Education is in the final stages of defining ACHD training requirements, which will require 24 months of fellowship training after general cardiology or pediatric cardiology, to be competent in the field of ACHD and to be board eligible for the certifying exam.
Therefore, for the sake of best care and outcomes for all our patients, we ask clinicians, authors, and editors to make a careful distinction between SHD and CHD. For all of us who are deeply embedded in the interventional aspects of our cardiology specialties, we know that rich understanding of the short- and longer-term outcomes (risks and benefits) that accompany interventions (and that require substantive experience and expertise beyond any particular technical skillset) is paramount for optimal patient outcomes, patient–physician trust, and innovation. Therefore, we humbly suggest consideration of the term “non-congenital SHD” when cardiologists mean to refer to interventions, such as TAVR or percutaneous mitral repair, targeted at acquired cardiac disease. Regardless of terminology, it is important for all providers to recognize that CHD, in children and adults, represents an important set of cardiac diagnoses whose patients have been demonstrated to benefit greatly from well-developed clinical and educational programs focused on their specific disorders.
Please note: All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation