부산대학교 도서관

Background: Patients with adult congenital heart disease （ACHD）who do not attend return-to-clinic （RTC）visits may experience, worsening of the condition and require advanced management.Purpose: To review the problems and countermeasures among ACHD who dropout （DO）during treatment.Subjects and Methods: Group A included 26 patients who made 27 RTC visits after DO, and Group B included 34 patients who did not attend 34 RTC visits after DO. We examined the diagnoses, surgical histories, DO age, New York Heart Association （NYHA）classification, DO reason, RTC reason, referral history, post-RTC treatments, and outcomes.Results: In Group A, DO age was < 15 years in 3, 16-19 years in 12, and adults in 12. The most common DO reasons were impossible diagnosis/treatment during childhood, treatment refusal, lack of subjective symptoms, and change of residence during adolescence and adulthood. Development of subjective symptoms was a commonest RTC reason, and symptomatic patients had worse conditions. Elucidating the clinical history was difficult in 18 patients （67%）at the RTC visit. Intervention was required in all cases with RTC visit, and the NYHA classification levels were similar/improved, except for 1 case of mortality. In Group B, 28 NYHA class I patients had minor conditions, but 4 of 6 class II patients had a DO history.Conclusion: Because DO is an important problem in ACHD treatment, pediatric cardiologist should educate patients from childhood to prevent DO during or after transition to adulthood.