Adult Congenital Center Cares for Increasing Number of Patients with High-Complexity Disease

Program expands regional footprint in fourth decade

Illustration of heart
Illustration of heart

The Duke Adult Congenital Heart Disease Center, one of the nation’s first programs devoted to congenital cardiac care in the adult, is expanding regional operations and providing advanced care for increasing numbers of patients with high-complexity disease.

Center Director Richard A. Krasuski, MD, says seven board-certified adult congenital cardiologists now treat more high-complexity congenital conditions than ever as the program enters its fourth decade. Duke specialists work regularly with patients with simple lesions or moderately complex disease, but high-complexity disease represents a more recent challenge. The center treats more than 2,000 adult patients and was among the first 20 programs to achieve accreditation from the Adult Congenital Heart Association.

“There are several types of heart lesions in patients that previously weren’t expected to survive to adulthood, but our pediatric surgical and medical colleagues have made their survival possible. Patients such as those with hypoplastic hearts often require added resources,” Krasuski says. Many patients live far from Duke clinics, heightening the need for collaboration and dialogue with regional physicians, he adds.

As part of its growing regional footprint, Duke offers adult congenital cardiovascular care in Fayetteville and Greensboro in existing pediatric clinics. The team emphasizes seamless care, which is important during the transition from pediatric to adult specialists. Significant complications can result without adequate follow-up.

“It’s very important that the patients remain in care and work with experienced, capable providers who are fully aware of their complex medical history and the need for regular follow-up,” Krasuski says. Surgical innovations and improved medical therapies have yielded improved outcomes for congenital heart patients of all ages. Many more infants with congenital conditions grow to adulthood and experience greater quality of life, Krasuski says.

“We are very fortunate to have so many board-certified adult congenital heart disease specialists within a single program,” Krasuski says. “Very few institutions have such an abundance of resources.”

Partnerships, preventative care are cornerstones of center

Krasuski was recruited from the Cleveland Clinic, where he built and ran the adult congenital program from 2005 to 2015. “The opportunity to come back ‘home’ to where I trained was too good for me to pass up.” The greatest appeal, he says, is the collaboration between pediatric and adult specialists. The center has established a regional approach as the program extends outreach across the Carolinas with several key steps:

Create partnerships: Support regional physicians caring for adults with congenital heart disease. If disease conditions become more complicated, Krasuski says Duke can offer more detailed assessment and treatment options following referral.

Promote preventive care: Help physicians anticipate complications related to the congenital heart lesion(s) and their treatments, as well as to help promote healthy and active lifestyles.

Assist with complex diagnoses: Offer guidance in treatment of unusual or concerning presentations during follow-up care. “Some aspects of this care can be overwhelming for busy providers,” he says.